ArticleJournal of the American Heart Association2025
Clinical Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction and With Reduced Ejection Fraction According to the Prognostic Nutritional Index: Findings From PARADIGM-HF and PARAGON-HF.
Article in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prognostic value of prognostic nutritional index in patients with heart failure: a systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2026Pooled it
- Article
- Prognostic Role of Immunonutritional Indices in Elderly Patients with HFpEF: Long-Term Follow-Up of the CONUT, PNI, and CALLy Scores.Journal of clinical medicine · 2026Article
- The Effectiveness of Current Inflammatory Indices and Clinical Scores in Early Diagnosis and Predicting Long-Term Mortality in Patients with Chronic Heart Failure.Biomedicines · 2026Article
- Drugs to Slow Progression of Chronic Kidney Disease: It Is a Whole New World!Kidney & blood pressure research · 2026Review
- Novel blood biomarkers for heart failure mortality: mechanistic pathways, aging biology, and risk stratification.Frontiers in cardiovascular medicine · 2026Review
- Association between prognostic nutritional index and major adverse cardiovascular events in patients with atrial fibrillation combined with heart failure with preserved ejection fraction.Frontiers in nutrition · 2026Article
- Pharmacological treatment for patients with obesity and heart failure: Focus on glucagon-like peptide-1 receptor agonists. European Journal of Heart Failure expert consensus document.European journal of heart failure · 2025Review
- Association between Prognostic Nutritional Index and Mortality Risk in Critically Ill Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study.International journal of chronic obstructive pulmonary disease · 2025Article
- Factors Influencing Malnutrition in Patients with Heart Failure: A Scoping Review Based on the Biopsychosocial Model.Risk management and healthcare policy · 2025Review
- The J-shaped association between the ratio of neutrophil counts to prognostic nutritional index and mortality in ICU patients with sepsis: a retrospective study based on the MIMIC database.Frontiers in cellular and infection microbiology · 2025Article
Corrections and comments
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Authors and funding
19 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe importance of nutritional status is underappreciated in patients with heart failure (HF). This study aimed to describe the range of the prognostic nutrition index (PNI), and the clinical characteristics and outcomes according to PNI, in patients with HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). The primary outcome was the composite of HF hospitalization or cardiovascular death. METHODS AND
resultsIndividual patient data from the PARAGON-HF (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ARB [Angiotensin Receptor Blocker] Global Outcomes in HFpEF) and PARADIGM-HF (Prospective Comparison of ARNI With ACEI [Angiotensin-Converting Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in HF) trials were used to examine patient characteristics and outcomes according to quartiles of PNI. Cox regression was used to analyze clinical outcomes, and multivariable fractional polynomial interaction analysis to examine the effects of sacubitril-valsartan, according to PNI. Patients with lower PNI (poorer nutrition) were older, frailer, and had more comorbidities and worse HF status, with greater congestion. Patients with lower PNI had biomarker abnormalities indicating inflammation, bone marrow suppression, and increased collagen turnover, among other physiologic perturbations. Lower PNI was associated with worse outcomes; that is, the rate of the primary end point among patients in the first quartile was 11.31 (10.20-12.54) compared with 7.09 (6.17-8.14) per 100 person-years in the fourth quartile. These associations persisted after adjustment for other prognostic variables. PNI did not modify the effects of sacubitril-valsartan in HFrEF although sacubitril/valsartan seemed to have a greater benefit in patients with HFpEF with a higher PNI.
conclusionsNutritional status, assessed using PNI, is an independent predictor of poor outcomes in HF. Evaluation of nutritional status in clinical practice, the causes of undernutrition, and whether undernutrition should be a therapeutic target, are all worthy of further investigation in HF.
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