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

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. Methods and Results: This multicenter, retrospective cohort study was conducted at 4 outpatient cardiology clinics between June 2021 and May 2023. Among 331 outpatients aged ≥65 years with stage B HF, 307 were included in the final analysis. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI). The primary endpoint was a composite of all-cause death or hospitalization for worsening HF during the 2-year follow-up period. The median GNRI was 102.8, and 22% (67/307) of patients were classified into the low-GNRI group (GNRI ≤ 98.0). Kaplan-Meier analysis showed that the low-GNRI group had a significantly higher incidence of the composite endpoint than the high-GNRI group (14.9% vs. 3.8%; log-rank P<0.001). In multivariable Cox proportional hazards models, a low GNRI was independently associated with adverse events (hazard ratio 3.41; 95% confidence interval 1.34-8.69; P=0.01). Conclusions: Low GNRI scores were independently associated with poorer long-term outcomes in older outpatients with stage B HF. Thus, the GNRI may serve as a simple and practical tool for early risk stratification of this population.