Analysis of factors associated with cognitive impairment in elderly patients hospitalized with chronic heart failure

Objective This study systematically investigates the prevalence of cognitive impairment (CI) and its associated factors among older inpatients with chronic heart failure (CHF), aiming to inform early clinical screening and targeted interventions. Methods A cross-sectional study consecutively enrolled 220 CHF inpatients aged ≥ 60 years from the Department of Cardiology and General Medicine at the Fourth Affiliated Hospital of Anhui Medical University between October 2024 and November 2025. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Demographic, clinical, and laboratory data–including NT-proBNP, lipid profiles, and left ventricular ejection fraction (LVEF) –were collected. Intergroup comparisons were performed, and variables significant in univariate analysis ( P < 0.05) were entered into multivariate logistic regression to identify independent predictors. Random forest variable importance analysis was conducted to validate model stability. Results: the prevalence of CI was 55.9%. Univariate analysis revealed significant differences in age, education, LVEF, smoking history, diabetes, and sleep quality (all P < 0.05). Multivariate logistic regression identified age ≥ 80 years (OR = 6.122, 95% CI: 2.695–27.979, P < 0.001), sleep disturbance (OR = 2.870, P = 0.016), diabetes (OR = 2.409, P = 0.040), and elevated NT-proBNP (>1000 pg/mL) as independent risk factors for CI. In contrast, education level of senior high school or above (OR = 0.186, P = 0.007) and LVEF ≥ 50% (OR = 0.035, P < 0.001) were protective. Random forest analysis confirmed LVEF as the most influential variable, followed by age and NT-proBNP. Conclusion Cognitive impairment is highly prevalent among older inpatients with CHF and is influenced by advanced age, elevated NT-proBNP, sleep disorders, diabetes, lower education, and reduced LVEF. These findings highlight the high prevalence and associated factors of cognitive impairment in elderly patients with chronic heart failure, which may enhance clinical awareness of cognitive status in this population.