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Nutrients
Volume 18
Issue 2
10.3390/nu18020189
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

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

by
Kazutaka Nogi
1,
Tomoya Ueda
1,*,
Atsushi Kyodo
1,
Satomi Ishihara
1,
Yasuki Nakada
1,
Yukihiro Hashimoto
1,
Hitoshi Nakagawa
1,
Taku Nishida
1,
Ayako Seno
1,
Kenji Onoue
1,
Makoto Watanabe
1,
Yoshihiko Saito
1,2 and
Shungo Hikoso
1
1
Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8522, Japan
2
Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango 636-0802, Japan
*
Author to whom correspondence should be addressed.
Nutrients 2026, 18(2), 189; https://doi.org/10.3390/nu18020189
Submission received: 4 November 2025 / Revised: 31 December 2025 / Accepted: 31 December 2025 / Published: 6 January 2026
(This article belongs to the Section Nutrition and Neuro Sciences)
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Abstract

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.
Keywords: geriatric nutritional risk index; heart failure; mini-mental state examination; elderly geriatric nutritional risk index; heart failure; mini-mental state examination; elderly
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MDPI and ACS Style

Nogi, K.; Ueda, T.; Kyodo, A.; Ishihara, S.; Nakada, Y.; Hashimoto, Y.; Nakagawa, H.; Nishida, T.; Seno, A.; Onoue, K.; et al. Prognostic Impact of Combined Nutritional and Cognitive Status on Long-Term Outcome in Acute Decompensated Heart Failure. Nutrients 2026, 18, 189. https://doi.org/10.3390/nu18020189

AMA Style

Nogi K, Ueda T, Kyodo A, Ishihara S, Nakada Y, Hashimoto Y, Nakagawa H, Nishida T, Seno A, Onoue K, et al. Prognostic Impact of Combined Nutritional and Cognitive Status on Long-Term Outcome in Acute Decompensated Heart Failure. Nutrients. 2026; 18(2):189. https://doi.org/10.3390/nu18020189

Chicago/Turabian Style

Nogi, Kazutaka, Tomoya Ueda, Atsushi Kyodo, Satomi Ishihara, Yasuki Nakada, Yukihiro Hashimoto, Hitoshi Nakagawa, Taku Nishida, Ayako Seno, Kenji Onoue, and et al. 2026. "Prognostic Impact of Combined Nutritional and Cognitive Status on Long-Term Outcome in Acute Decompensated Heart Failure" Nutrients 18, no. 2: 189. https://doi.org/10.3390/nu18020189

APA Style

Nogi, K., Ueda, T., Kyodo, A., Ishihara, S., Nakada, Y., Hashimoto, Y., Nakagawa, H., Nishida, T., Seno, A., Onoue, K., Watanabe, M., Saito, Y., & Hikoso, S. (2026). Prognostic Impact of Combined Nutritional and Cognitive Status on Long-Term Outcome in Acute Decompensated Heart Failure. Nutrients, 18(2), 189. https://doi.org/10.3390/nu18020189

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