Impact of dementia and its progression on mortality in heart failure with preserved ejection fraction -insight from the KUNIUMI registry chronic cohort-

BACKGROUND Heart failure (HF) with preserved ejection fraction (HFpEF) is highly prevalent among older adults, while dementia is also an age-related condition characterized by cognitive decline, behavioral changes, and functional impairment. Although cognitive dysfunction is associated with worse outcomes in general HF populations, the specific prognostic implications of dementia and its progression in HFpEF remain unclear. This study aimed to investigate these associations in a real-world elderly HFpEF cohort. METHODS This prospective study included 965 patients with HFpEF without a history of stroke, drawn from 1646 consecutive HF patients in the KUNIUMI Registry Chronic Cohort, a population-based registry in Japan. Dementia was defined as an ABC Dementia Scale (ABC-DS) score < 100, and dementia progression as a ≥ 14-point decline in ABC-DS over 1 year. The primary endpoint was all-cause death, and the secondary endpoint was cardiovascular death or HF hospitalization over a mean follow-up of 2.0 ± 0.1 years. RESULTS Patients with dementia had significantly higher rates of all-cause death and cardiovascular death or HF hospitalization than those without dementia. These findings remained consistent after adjustment for baseline characteristics using propensity score matching. Furthermore, patients with dementia progression at 1 year had significantly higher all-cause death and cardiovascular death or HF hospitalization than those without progression. In multivariable Cox regression analysis, dementia progression was associated with all-cause death. CONCLUSIONS Dementia, especially its progression, was associated with worse prognosis in HFpEF. These findings highlight the importance of longitudinal cognitive assessment to improve risk stratification and guide management strategies.