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
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 fractio...
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2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| author | Simone Solano Mingming Yang Paolo Tolomeo Toru Kondo Li Shen Pardeep S. Jhund Inder S. Anand Akshay S. Desai Carolyn S. P. Lam Aldo P. Maggioni Felipe A. Martinez Jean L. Rouleau Muthiah Vaduganathan Dirk J. van Veldhuisen Faiez Zannad Michael R. Zile Milton Packer Scott D. Solomon John J. V. McMurray |
| author_facet | Simone Solano Mingming Yang Paolo Tolomeo Toru Kondo Li Shen Pardeep S. Jhund Inder S. Anand Akshay S. Desai Carolyn S. P. Lam Aldo P. Maggioni Felipe A. Martinez Jean L. Rouleau Muthiah Vaduganathan Dirk J. van Veldhuisen Faiez Zannad Michael R. Zile Milton Packer Scott D. Solomon John J. V. McMurray |
| author_sort | Simone Solano |
| collection | DOAJ |
| description | 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 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. 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. |
| format | Article |
| id | doaj-art-ac41d1f6a7fc464fb627b8ab2d354db2 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-ac41d1f6a7fc464fb627b8ab2d354db22025-08-20T02:34:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114110.1161/JAHA.124.037782Clinical 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‐HFSimone Solano0Mingming Yang1Paolo Tolomeo2Toru Kondo3Li Shen4Pardeep S. Jhund5Inder S. Anand6Akshay S. Desai7Carolyn S. P. Lam8Aldo P. Maggioni9Felipe A. Martinez10Jean L. Rouleau11Muthiah Vaduganathan12Dirk J. van Veldhuisen13Faiez Zannad14Michael R. Zile15Milton Packer16Scott D. Solomon17John J. V. McMurray18BHF Cardiovascular Research Centre University of Glasgow United KingdomBHF Cardiovascular Research Centre University of Glasgow United KingdomBHF Cardiovascular Research Centre University of Glasgow United KingdomBHF Cardiovascular Research Centre University of Glasgow United KingdomBHF Cardiovascular Research Centre University of Glasgow United KingdomBHF Cardiovascular Research Centre University of Glasgow United KingdomDepartment of Cardiovascular Medicine University of Minnesota Minneapolis MN USACardiovascular Division Brigham and Women’s Hospital, and Harvard Medical School Boston MA USANational Heart Centre Singapore & Duke‐National University of Singapore SingaporeANMCO Research Center Heart Care Foundation Florence ItalyUniversidad Nacional de Córdoba Córdoba ArgentinaInstitut de Cardiologie de Montréal Université de Montréal Montreal QC CanadaCardiovascular Division Brigham and Women’s Hospital, and Harvard Medical School Boston MA USADepartment of Cardiology, Thorax Center University Medical Center Groningen The NetherlandsInserm CIC 1433 and Université de Lorraine Centre Hospitalier Régional Universitaire Nancy FranceRHJ Department of Veterans Affairs Medical Center Medical University of South Carolina Charleston SC USABaylor Heart and Vascular Institute Baylor University Medical Center Dallas TX USACardiovascular Division Brigham and Women’s Hospital, and Harvard Medical School Boston MA USABHF Cardiovascular Research Centre University of Glasgow United KingdomBackground 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 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. 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.https://www.ahajournals.org/doi/10.1161/JAHA.124.037782heart failuremalnutritionoutcomesprognosissacubitril‐valsartan |
| spellingShingle | Simone Solano Mingming Yang Paolo Tolomeo Toru Kondo Li Shen Pardeep S. Jhund Inder S. Anand Akshay S. Desai Carolyn S. P. Lam Aldo P. Maggioni Felipe A. Martinez Jean L. Rouleau Muthiah Vaduganathan Dirk J. van Veldhuisen Faiez Zannad Michael R. Zile Milton Packer Scott D. Solomon John J. V. McMurray 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 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure malnutrition outcomes prognosis sacubitril‐valsartan |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | heart failure malnutrition outcomes prognosis sacubitril‐valsartan |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037782 |
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