Association Between Prognostic Nutritional Index and Major Adverse Cardiovascular Events in Patients with Atrial Fibrillation Combined with Heart Failure with Preserved Ejection Fraction

Why It Matters

PNI offers a simple, inexpensive biomarker that can enhance risk stratification for a high‑risk AF‑HFpEF population, potentially guiding more aggressive nutritional or therapeutic interventions.

Key Takeaways

• Higher PNI linked to significantly lower MACE risk.
• Top PNI tertile reduced mortality hazard to 0.174.
• PNI’s AUC for MACE prediction was modest at 0.65.
• Findings held across age, gender, and comorbidity subgroups.
• Study suggests PNI as low‑cost adjunctive risk marker.

Pulse Analysis

Atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), creating a patient subgroup with outsized morbidity and mortality. Traditional risk models rely on hemodynamic and imaging parameters, yet they often overlook the contribution of systemic factors such as nutrition and inflammation. Emerging evidence links malnutrition to adverse cardiovascular outcomes, prompting investigators to explore readily available indices that capture both nutritional status and immune competence. The prognostic nutritional index (PNI), calculated from serum albumin and lymphocyte count, fits this niche and has been studied in various cardiac conditions, but its relevance to AF‑HFpEF patients remained unclear until now.

In the recent Yancheng First Hospital study, baseline PNI demonstrated a robust inverse relationship with both major adverse cardiovascular events (MACE) and all‑cause death. After adjusting for age, comorbidities, biomarkers, and medication use, each incremental PNI point lowered MACE hazard by roughly 10%, while patients in the highest tertile experienced a 63% risk reduction compared with the lowest. Although the area under the ROC curve was only 0.65—indicating moderate discriminative power—PNI’s ease of measurement and low cost make it an attractive adjunct to established risk scores such as CHA₂DS₂‑VASc and NT‑proBNP. Moreover, subgroup analyses showed consistent benefits across older adults, both sexes, and common comorbidities, suggesting broad applicability.

The clinical takeaway is that integrating PNI into routine assessment could flag vulnerable patients who might benefit from targeted nutritional support, anti‑inflammatory strategies, or closer surveillance. However, the study’s single‑center, retrospective design and reliance on a single baseline PNI measurement limit definitive conclusions. Prospective multicenter trials are needed to validate PNI’s incremental value over existing models and to determine whether interventions that improve PNI translate into tangible outcome gains. Until such data emerge, clinicians should consider PNI as a complementary tool rather than a standalone predictor in the complex management of AF‑HFpEF patients.