April 23, 2025Journal of the American Heart Association11 citationsOpen Access
Prognostic Significance of Nutritional Scores in Patients With Heart Failure: Insights From the PARAGON‐HF Trial
Key Result
Any hospitalization in patients with HFpEF was associated with a higher risk of developing an abnormal nutritional score compared with never-hospitalized patients (adjusted HR 1.37; 95% CI 1.22-1.55).
Study Design
Type
RCT (n=4,794)
Multicenter
Yes
Structured PICO
Do abnormal nutritional scores (CONUT or GNRI) predict adverse outcomes in patients with heart failure with preserved ejection fraction?
P
Population
4,794 patients with heart failure with preserved ejection fraction (HFpEF), mean age 72±8 years, 55% women.
I
Intervention
Abnormal nutritional scores (CONUT score >2 or GNRI ≤98)
C
Comparator
Normal nutritional scores
O
Outcome
Total heart failure hospitalizations and cardiovascular deathcomposite
In patients with HFpEF, abnormal nutritional scores are common, frequently develop after hospitalization, and are associated with an increased risk of adverse clinical outcomes.
Main Result
Effect estimate: adjusted HR 1.37 (95% CI 1.22-1.55)
Abstract
BACKGROUND: The Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) are indices that identify individuals at risk of malnutrition. Our study sought to examine the incidence and prognostic implications of abnormal CONUT and/or GNRI in patients with heart failure with preserved ejection fraction. METHODS AND RESULTS: The CONUT score and GNRI were serially analyzed in this post hoc analysis of the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. A CONUT score >2 or GNRI ≤98 was considered to be abnormal. The association between abnormal CONUT and/or GNRI (analyzed using a time-updated approach) and total heart failure hospitalizations and cardiovascular death was analyzed. Other outcomes included cardiovascular death, all-cause death, total heart failure hospitalizations, first all-cause hospitalization, and first noncardiovascular hospitalization. We also explored the effect of incident hospitalization on subsequent incident abnormal CONUT and/or GNRI. In 4794 patients (55% women, mean age 72±8 years), 1119 (23.3%) had at least 1 abnormal score at randomization. Among the remaining 3675 patients, 1405 (38.2%) developed at least 1 abnormal score over a median follow-up of 2.9 years. Any abnormal score during follow-up was associated with a significantly higher risk of fatal and nonfatal outcomes, and all types of hospitalizations (all-cause, heart failure, and noncardiovascular hospitalizations). Among patients with normal scores at randomization, any hospitalization during follow-up was associated with a significantly higher risk of developing at least 1 abnormal score posthospitalization, compared with prehospitalization and never-hospitalized patients (adjusted hazard ratio, 1.37 95% CI, 1.22-1.55). CONCLUSIONS: Among patients with heart failure with preserved ejection fraction, the rate of individuals with abnormal CONUT and/or GNRI was high, especially following a heart failure hospitalization, and was linked with excess cardiovascular and noncardiovascular events. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.