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

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.