Prognostic value of CONUT, PNI, albumin, and BMI in patients with heart failure and atrial fibrillation: A retrospective cohort study

Malnutrition is one of the common complications of heart failure (HF). In recent years, malnutrition has been proven to be associated with an increased risk of cardiovascular death, therefore, assessing HF patients' nutritional status is essential. To date, several nutritional indicators have been proven to have a predictive value in patients with HF and atrial fibrillation (AF), therefore, in this study, we aimed to investigate Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index (PNI), body mass index (BMI), and albumin in patients with HF and AF (HF-AF). Data from 570 consecutive patients diagnosed with HF-AF between January 2018 to December 2018 were collected. The primary endpoint was all-cause mortality. The subgroup analysis was done by analyzing the impact of different types of AF (paroxysmal AF, persistent AF, and long-standing AF) on nutritional indexes and long-term mortality. During a median follow-up of 1194 days, we discovered that the non-survivor group tended to have a higher CONUT score, lower BMI, lower PNI, and lower albumin level (all P < .05). Multivariate analysis was performed to assess the prognostic ability of available nutritional indicators, and we found that CONUT score ≥ 5 [hazard ratio [HR]: 2.139; 95% confidence interval [CI]: 1.598-2.863, P < .001], age > 65 years old [HR: 2.798; 95% CI: 1.647-4.752, P < .001], and urea [HR: 1.035; 95% CI: 1.015-1.057, P < .001] may serve as an independent prognostic biomarker in HF-AF patients. Malnutrition was associated with higher mortality in patients with HF-AF. Among the available nutritional risk stratification tools, CONUT score was a better prognostic tool compared to PNI, albumin, and BMI.