TY - JOUR
T1 - Clinical Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction and With Reduced Ejection Fraction According to the Prognostic Nutritional Index
T2 - Findings From PARADIGM-HF and PARAGON-HF
AU - Solano, Simone
AU - Yang, Mingming
AU - Tolomeo, Paolo
AU - Kondo, Toru
AU - Shen, Li
AU - Jhund, Pardeep S.
AU - Anand, Inder S.
AU - Desai, Akshay S.
AU - Lam, Carolyn S.P.
AU - Maggioni, Aldo P.
AU - Martinez, Felipe A.
AU - Rouleau, Jean L.
AU - Vaduganathan, Muthiah
AU - van Veldhuisen, Dirk J.
AU - Zannad, Faiez
AU - Zile, Michael R.
AU - Packer, Milton
AU - Solomon, Scott D.
AU - McMurray, John J.V.
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2025/1/7
Y1 - 2025/1/7
N2 - BACKGROUND: The 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 RESULTS: Individual 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 personyears 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. CONCLUSIONS: Nutritional 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.
AB - BACKGROUND: The 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 RESULTS: Individual 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 personyears 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. CONCLUSIONS: Nutritional 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.
KW - heart failure
KW - malnutrition
KW - outcomes
KW - prognosis
KW - sacubitril-valsartan
UR - http://www.scopus.com/inward/record.url?scp=85215145729&partnerID=8YFLogxK
U2 - 10.1161/JAHA.124.037782
DO - 10.1161/JAHA.124.037782
M3 - Article
C2 - 39719408
AN - SCOPUS:85215145729
SN - 2047-9980
VL - 14
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 1
M1 - e037782
ER -