Prognostic Impact of Combined Nutritional and Cognitive Status on Long-Term Outcome in Acute Decompensated Heart Failure

TL;DR

Combining nutritional and cognitive assessments improves prediction of long-term outcomes in elderly heart failure patients.

Contribution

This study demonstrates the added prognostic value of combining GNRI and MMSE in elderly acute decompensated heart failure patients.

Findings

Patients with low GNRI and low MMSE had significantly worse outcomes than those with high GNRI and high MMSE.

The combined impact of nutritional and cognitive status was consistent across age subgroups.

The composite endpoint of mortality and readmission was reached by over half of the patients during follow-up.

Abstract

Background/Objectives: Malnutrition and cognitive impairment are both common and prognostically significant in elderly patients with acute decompensated heart failure (ADHF). However, the combined impact of nutritional and cognitive status on long-term outcomes remains unclear. This study aimed to evaluate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) and Mini-Mental State Examination (MMSE) in elderly patients hospitalized for ADHF. Methods: We analyzed 414 ADHF patients aged ≥65 years from the NARA-LONGEVITY study. Patients were categorized into four groups based on GNRI (≥92 or <92) and MMSE (>23 or ≤23) values at discharge. The primary endpoint was a composite of all-cause mortality and HF-related readmission. Results: During a median follow-up of 37.4 months, 218 patients (52.7%) reached the composite endpoint, and 168 (40.6%) died. Patients with both low GNRI and low MMSE had significantly poorer outcomes than those with high GNRI and high MMSE (adjusted hazard ratio [HR] for composite outcome: 2.16; 95% CI, 1.28–3.64; p = 0.004; HR for all-cause mortality: 2.21; 95% CI, 1.22–3.99; p = 0.009). The combined prognostic impact was consistent across age subgroups. Conclusions: The combined assessment of nutritional and cognitive status using GNRI and MMSE at discharge provides additional prognostic value in elderly patients with ADHF. These findings highlight the importance of a multidimensional approach to risk stratification and personalized care planning in this population.

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