Impact of Nutritional Risk on Long-Term Prognosis in Older Patients With Stage B Heart Failure ― A PAPRIKA-HF Registry Subanalysis ―

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Stage B Heart Failure (n=307). Intervention: Low Geriatric Nutritional Risk Index (GNRI ≤ 98.0) vs. High GNRI (GNRI > 98.0). Primary outcome: Composite of all-cause death or hospitalization for worsening HF (HR 3.41, 95% CI 1.34-8.69, p=0.01).

Q: What does this research mean for the field?

Nutritional risk is associated with adverse long-term prognosis in older outpatients with stage B heart failure. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shohei Hakozaki; Koichiro Matsumura; Shun Morishita; Junko Morimoto; Satoshi Kurose; Kosuke Fujita; Takayuki Kawamura; Eijiro Yagi; Hiroki Matsuzoe; Masafumi Ueno; Yutaka Kimura; Gaku Nakazawa

doi:10.1253/circrep.cr-26-0047

September 1, 2026Circulation ReportsOpen Access

Impact of Nutritional Risk on Long-Term Prognosis in Older Patients With Stage B Heart Failure ― A PAPRIKA-HF Registry Subanalysis ―

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Key result

A low Geriatric Nutritional Risk Index was independently associated with a significantly higher risk of all-cause death or heart failure hospitalization (HR 3.41) compared to a high GNRI.

Why the study?

Malnutrition is linked to adverse outcomes in hospitalized heart failure patients, but its prognostic impact in outpatients with stage B heart failure remains unclear.

Does a low Geriatric Nutritional Risk Index predict all-cause mortality or heart failure hospitalization in older outpatients with stage B heart failure?

Key Points

To assess the prognostic value of nutritional risk evaluated by the Geriatric Nutritional Risk Index (GNRI) in older outpatients with stage B heart failure.
Subanalysis of the PAPRIKA-HF registry evaluating 307 outpatients aged 65 years or older with stage B heart failure.
Patients were categorized into low-GNRI (GNRI ≤98.0, n=67) and high-GNRI (GNRI >98.0, n=240) groups based on baseline body weight and serum albumin levels.
Outcomes, including a 2-year composite endpoint, all-cause mortality, and heart failure hospitalizations, were evaluated alongside sarcopenia and physical performance metrics.
Over the 2-year follow-up period, the primary composite outcome occurred in 14.9% (10/67) of the low-GNRI group versus 3.8% (9/240) of the high-GNRI group (log-rank P<0.001; adjusted HR 3.41; 95% CI 1.34–8.69; P=0.01).
Two-year all-cause mortality was 9.0% (6/67) in the low-GNRI group compared to 2.1% (5/240) in the high-GNRI group (log-rank P<0.001), while heart failure hospitalization was 5.7% (4/67) versus 1.7% (4/240; log-rank P=0.045).
Sarcopenia was more prevalent in the low-GNRI group than in the high-GNRI group (34.3% [23/67] vs. 13.5% [32/238]; P<0.001), with lower muscle mass, handgrip strength, and gait speed.

Study Design

Type

Cohort (n=307)

Multicenter

Yes

Structured PICO

Does a low Geriatric Nutritional Risk Index predict all-cause mortality or heart failure hospitalization in older outpatients with stage B heart failure?

P

Population

307 older outpatients (aged ≥65 years) with stage B heart failure and no prior heart failure hospitalization, followed for 2 years.

E

Exposure

Low Geriatric Nutritional Risk Index (GNRI ≤98.0)

C

Comparator

High Geriatric Nutritional Risk Index (GNRI >98.0)

O

Outcome

Composite of all-cause mortality or hospitalization for worsening heart failure during the 2-year follow-up periodcomposite

Main Result

Hazard Ratio: 3.41 (95% CI 1.34–8.69)

Absolute Event Rate: 14.9% vs 3.8%

p-value: p=0.01

A low Geriatric Nutritional Risk Index is independently associated with poorer long-term outcomes in older outpatients with stage B heart failure, highlighting its potential as a simple tool for early risk stratification.

Limitations

Retrospective observational study, meaning causal relationships cannot be definitively established
Modest sample size limited to a single ethnic group
Longitudinal changes in the GNRI were not assessed
Number of primary outcome events was relatively small, which may cause model instability
Retrospective observational study, causal relationships cannot be definitively established
Modest sample size and limited to a single ethnic group
Relatively small number of primary outcome events

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Implication

Nutritional risk may stratify prognosis in older stage B HF outpatients; extends hospitalized data but leaves open whether screening or intervention alters outcomes.

Abstract

Background: Malnutrition is a common geriatric syndrome associated with adverse long-term outcomes in hospitalized patients with heart failure (HF). However, its prognostic impact in outpatients with stage B HF remains unclear.

Discussion

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Cite This Study

Hakozaki et al. (2026) conducted a cohort in Stage B Heart Failure (n=307). Low Geriatric Nutritional Risk Index (GNRI ≤ 98.0) vs. High GNRI (GNRI > 98.0) was evaluated on Composite of all-cause death or hospitalization for worsening HF (HR 3.41, 95% CI 1.34-8.69, p=0.01). A low Geriatric Nutritional Risk Index was independently associated with a significantly higher risk of all-cause death or heart failure hospitalization (HR 3.41) compared to a high GNRI.

synapsesocial.com/papers/6a993547636c6408cfa7d5e4 https://doi.org/10.1253/circrep.cr-26-0047

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Impact of Nutritional Risk on Long-Term Prognosis in Older Patients With Stage B Heart Failure ― A PAPRIKA-HF Registry Subanalysis ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of Nutritional Risk on Long-Term Prognosis in Older Patients With Stage B Heart Failure ― A PAPRIKA-HF Registry Subanalysis ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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