Predicting Cognitive Impairment in Elderly Patients with HFpEF: Development of a Simple Clinical Risk Score

Figures

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  Figure 1. Boxplot showing the distribution of age according to Mini-Mental State Examination-2 (MMSE-2) score categories. The central line within each box indicates the median; the box limits represent the interquartile range (IQR); whiskers denote the range excluding outliers. Bonferroni-corrected p-values are displayed for each pairwise comparison between MMSE groups. *** = p < 0.001, ns = not significant.

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  Figure 2. Forest plot of odds ratios with 95% confidence intervals of the independent predictors of an MMSE-2 score < 24, identified by multivariable logistic regression. Abbreviations: HFpEF, heart failure with preserved ejection fraction; AD, artery disease; TIA, transient ischemic attack; eGFR, estimated glomerular filtration rate; KCCQ, Kansas City Cardiomyopathy Questionnaire; MMSE, Mini-Mental State Examination; NT-proBNP, N-terminal pro–B-type natriuretic peptide; TIA, transient ischemic attack.

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  Figure 3. The distribution of the key predicting factors among the HFpEF patients. Histograms (top row) display the distribution of continuous variables: KCCQ score, eGFR, and NT-proBNP. KCCQ scores are generally high, with most patients scoring above 60, indicating preserved quality of life. eGFR values show a moderate spread, reflecting variation in renal function across the cohort. NT-proBNP levels exhibit a right-skewed distribution, consistent with clinical variability observed in heart failure. Bar plots (bottom row) show the frequency of binary variables: diabetes mellitus, history of stroke or transient ischemic attack (TIA), and anticoagulant use for atrial fibrillation. These categorical predictors demonstrate distinct group distributions, supporting their relevance in the assessment of cognitive risk in HFpEF.

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  Figure 4. The distribution of key clinical predictors stratified by cognitive status (MMSE < 24 vs. ≥24) in HFpEF patients. Top row: Boxplots show continuous variables—KCCQ score, eGFR, and NT-proBNP. Patients with preserved cognition (MMSE ≥ 24) exhibit higher KCCQ scores and eGFR, while NT-proBNP levels are elevated and right-skewed in the cognitively impaired group (MMSE < 24). Bottom row: Bar plots represent the proportions of patients with diabetes mellitus, history of stroke/TIA, and use of anticoagulants for atrial fibrillation. Comorbidities are more frequent in the MMSE < 24 group, while anticoagulant use is higher among cognitively preserved patients, suggesting a potential protective effect.

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  Figure 5. Distribution of cognitive impairment risk scores in HFpEF patients.

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  Figure 6. Receiver operating characteristic (ROC) curve evaluating the performance of the cognitive impairment risk score in predicting MMSE-2 scores < 24 among HFpEF patients.