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

To explore the prevalence and associated factors of cognitive frailty in older adults with heart failure. A systematic review and meta-analysis. We systematically searched China National Knowledge Infrastructure (CNKI), Wanfang Data, the VIP Database, SinoMed, PubMed, Web of Science, Embase, the Cochrane Library and Scopus from their inception to March 30, 2026. A total of 22 studies involving 8,892 older adults with heart failure were included. The meta-analysis showed that the pooled prevalence of cognitive frailty in older adults with heart failure was 32% (95% CI: 27%-37%). Descriptive stratified analyses yielded pooled prevalence estimates of 37% in women and 31% in men. According to New York Heart Association functional classification, the corresponding estimates were 44% among patients classified as class IV and 28% among those classified as classes II-III.The prevalence was also higher in patients with comorbid chronic obstructive pulmonary disease (46%) and coronary heart disease (31%). Older age was associated with higher odds of cognitive frailty (adjusted OR = 1.12, 95% CI 1.06-1.18). Depression was also associated with higher odds, whereas exercise and intellectual activity were associated with lower odds. Cognitive frailty appears to be common among older adults with heart failure, although prevalence estimates vary across populations and assessment approaches. Older age and depression were associated with higher odds of cognitive frailty, whereas exercise and intellectual activity were associated with lower odds. These findings support early screening and comprehensive assessment, while the observed associations should not be interpreted as causal because the available evidence was predominantly observational and cross-sectional. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261360024, PROSPERO, identifier CRD420261360024.