Prevalence and associated factors of cognitive frailty in older adults with heart failure: a systematic review and meta-analysis.

The pooled prevalence of cognitive frailty in older adults with heart failure was 32%.

• Meta-analysis included 22 studies involving 8,892 older adults with heart failure.
• Pooled prevalence estimate was 32% (95% CI: 27%-37%).
• Studies were sourced from nine databases searched from inception to March 30, 2026.
• Prevalence estimates varied across populations and assessment approaches.

Prevalence of cognitive frailty was higher in women (37%) than in men (31%) among older adults with heart failure.

• Descriptive stratified analyses yielded a pooled prevalence estimate of 37% in women.
• Pooled prevalence estimate in men was 31%.
• These estimates were derived from descriptive stratified analyses rather than direct comparative statistical testing.

Cognitive frailty prevalence was higher in patients with more severe heart failure (NYHA class IV) compared to less severe classifications.

• Prevalence among patients classified as NYHA class IV was 44%.
• Prevalence among patients classified as NYHA classes II-III was 28%.
• New York Heart Association (NYHA) functional classification was used to stratify patients by heart failure severity.

Cognitive frailty prevalence was higher in heart failure patients with comorbid chronic obstructive pulmonary disease (COPD) or coronary heart disease.

• Prevalence in patients with comorbid COPD was 46%.
• Prevalence in patients with comorbid coronary heart disease was 31%.
• These estimates were derived from descriptive stratified analyses.

Older age was associated with higher odds of cognitive frailty in older adults with heart failure.

• Adjusted OR for older age was 1.12 (95% CI: 1.06-1.18).
• This association was reported as an adjusted odds ratio, suggesting it was derived from multivariable analyses within included studies.
• The available evidence was predominantly observational and cross-sectional, precluding causal interpretation.

Depression was associated with higher odds of cognitive frailty, while exercise and intellectual activity were associated with lower odds of cognitive frailty.

• Depression was identified as a factor associated with higher odds of cognitive frailty.
• Exercise was associated with lower odds of cognitive frailty.
• Intellectual activity was associated with lower odds of cognitive frailty.
• The authors cautioned that these associations should not be interpreted as causal given the predominantly observational and cross-sectional nature of the evidence.