Table 1
Patient characteristics before propensity score matching.
| NON-IMP | IMP | P VALUE | |
|---|---|---|---|
| n = 644 | n = 168 | ||
| Age, years | 76.60 ± 12.25 | 69.13 ± 15.63 | <0.0001 |
| Female, n (%) | 225 (34.94) | 67 (39.88) | 0.237 |
| History of hospitalization of HF, n (%) | 276 (42.86) | 61 (36.31) | 0.123 |
| Hypertension, n (%) | 447 (69.41) | 103 (61.31) | 0.048 |
| Diabetes mellitus, n (%) | 279 (43.32) | 56 (33.33) | 0.018 |
| Dyslipidemia, n (%) | 248 (38.51) | 57 (33.93) | 0.272 |
| Hyperuricemia, n (%) | 209 (32.45) | 952 (30.95) | 0.710 |
| Chronic kidney disease, n (%) | 348 (54.04) | 67 (39.88) | 0.001 |
| Anemia, n (%) | 255 (39.60) | 45 (26.79) | 0.002 |
| Ischemic heart disease, n (%) | 257 (39.91) | 42 (25.00) | 0.0003 |
| Atrial fibrillation, n (%) | 297 (46.12) | 72 (42.86) | 0.449 |
| BMI, kg/m2 | 23.30 ± 4.82 | 24.10 ± 5.16 | 0.061 |
| Systolic blood pressure, mm Hg | 133.79 ± 29.12 | 133.71 ± 33.92 | 0.978 |
| Diastolic blood pressure, mm Hg | 77.56 ± 19.30 | 81.34 ± 20.20 | 0.025 |
| Heart rate, bpm | 88.09 ± 23.54 | 91.53 ± 21.04 | 0.086 |
| NYHA3/4 | 588 (91.31) | 153 (91.07) | 0.646 |
| Dyspnea, n (%) | 580 (90.06) | 149 (88.69) | 0.605 |
| S3, n (%) | 151 (23.45) | 48 (28.57) | 0.175 |
| Rales, n (%) | 281 (43.63) | 66 (39.29) | 0.309 |
| Eedema, n (%) | 482 (74.84) | 130 (77.38) | 0.494 |
| Anorexia, n (%) | 117 (18.17) | 40 (23.81) | 0.106 |
| medication on admission | |||
| ACEI, n (%) | 124 (19.25) | 38 (22.62) | 0.337 |
| ARB, n (%) | 178 (27.64) | 36 (21.43) | 0.100 |
| Beta blockers, n (%) | 334 (51.86) | 78 (46.43) | 0.210 |
| MRA, n (%) | 192 (29.81) | 56 (33.33) | 0.381 |
| Loop diuretics, n (%) | 390 (60.56) | 95 (56.55) | 0.347 |
| Thiazides, n (%) | 30 (4.66) | 4 (2.38) | 0.162 |
| Tolvaptan, n (%) | 145 (22.52) | 28 (16.67) | 0.092 |
| Nitrates, n (%) | 71 (11.02) | 5 (2.98) | 0.0004 |
| Calcium channel blockers, n (%) | 223 (34.63) | 51 (30.36) | 0.294 |
| Inotropes, n (%) | 49 (7.61) | 13 (7.74) | 0.955 |
| SGLT2I, n (%) | 44 (6.83) | 10 (5.95) | 0.680 |
| DOAC, n (%) | 178 (27.64) | 42 (25.00) | 0.490 |
| Antiplatelet, n (%) | 206 (31.99) | 33 (19.64) | 0.001 |
| ARNI, n (%) | 3 (0.83) | 0 (0.0) | 0.220 |
| Statin, n (%) | 241 (37.42) | 49 (29.17) | 0.044 |
| Laboratory data | |||
| White blood cell, /μL | 7030.37 ± 3294.30 | 7274.74 ± 3332.70 | 0.393 |
| Lymphocyte,/μL | 975.94 ± 686.37 | 898.33 ± 500.77 | 0.170 |
| hemoglobin, g/dL | 10.89 ± 2.31 | 11.65 ± 2.23 | 0.0002 |
| Hematocrit, % | 33.42 ± 6.89 | 35.63 ± 6.52 | 0.0002 |
| Blood urea nitrogen, mg/dL | 30.28 ± 16.71 | 25.20 ± 14.85 | 0.0004 |
| Creatinine, mg/dL | 1.628 ± 1.304 | 1.291 ± 0.874 | 0.0016 |
| eGFR, mL/min/173 m2 | 41.680 ± 21.41 | 51.35 ± 24.06 | <0.0001 |
| Uric acid, mg/dL | 6.956 ± 2.428 | 6.955 ± 2.628 | 0.996 |
| Sodium, mEq/L | 138.62 ± 5.21 | 138.64 ± 5.54 | 0.964 |
| Potassium, mEq/L | 4.195 ± 0.667 | 4.071 ± 0.622 | 0.029 |
| Chloride, mEq/L | 103.56 ± 5.465 | 102.85 ± 5.862 | 0.144 |
| Total protein, g/dL | 6.350 ± 0.776 | 6.216 ± 0.676 | 0.041 |
| Albumin, g/dL | 3.11 ± 0.46 | 3.23 ± 0.42 | 0.0023 |
| Total bilirubin, mg/dL | 1.065 ± 0.927 | 1.274 ± 1,140 | 0.014 |
| Total cholesterol, mg/dL | 136.65 ± 40.73 | 145.52 ± 31.59 | 0.001 |
| Triglycerides, mg/dL | 79.98 ± 41.59 | 80.79 ± 40.47 | 0.823 |
| HDL-cholesterol, mg/dL | 45.06 ± 14.64 | 46.91 ± 14.72 | 0.155 |
| LDL-cholesterol, mg/dL | 75.04 ± 32.51 | 81.67 ± 27.31 | 0.018 |
| BNP, pg/mL | 1055.51 ± 961.91 | 1110.36 ± 950.36 | 0.584 |
| NT-proBNP, pg/mL | 11867.01 ± 16417.64 | 7245.56 ± 6576.99 | 0.023 |
| CONUT score on admission | 6.315 ± 1.453 | 5.863 ± 1.183 | 0.0001 |
| CONUT score at discharge | 6.943 ± 1.722 | 3.560 ± 0.498 | <0.0001 |
| Echocardiographic parameter | |||
| LV end-diastolic diameter, mm | 51.37 ± 9.84 | 52.49 ± 9.80 | 0.197 |
| LV systolic diameter, mm | 39.00 ± 11.82 | 41.14 ± 12.30 | 0.043 |
| LV ejection fraction, % | 47.06 ± 16.48 | 43.44 ± 16.81 | 0.0134 |
| LA diameter, mm | 44.59 ± 8.85 | 44.65 ± 11.00 | 0.937 |
| LA volume, mL | 91.90 ± 53.58 | 99.85 ± 69.84 | 0.203 |
| IVST, mm | 9.98 ± 2.35 | 9.69 ± 2.40 | 0.169 |
| PWT, mm | 9.89 ± 2.05 | 10.02 ± 2.54 | 0.480 |
| E wave, cm/s | 86.22 ± 33.81 | 86.43 ± 36.19 | 0.946 |
| A wave, cm/s | 73.67 ± 32.29 | 64.60 ± 26.93 | 0.011 |
| TAPSE | 16.48 ± 4.83 | 15.96 ± 4.51 | 0.353 |
| TRPG, mm Hg | 30.18 ± 12.92 | 27.82 ± 13.06 | 0.050 |
| medication at discharge | |||
| ACEI, n (%) | 226 (35.09) | 81 (48.21) | 0.002 |
| ARB, n (%) | 179 (27.80) | 46 (27.38) | 0.915 |
| Beta blockers, n (%) | 476 (73.91) | 134 (79.76) | 0.112 |
| MRA, n (%) | 353 (54.81) | 110 (65.48) | 0.0122 |
| Loop diuretics, n (%) | 542 (84.16) | 143 (85.12) | 0.760 |
| Thiazides, n (%) | 45 (6.99) | 8 (4.76) | 0.281 |
| Tolvaptan, n (%) | 260 (40.37) | 57 (33.93) | 0.125 |
| Nitrates, n (%) | 47 (7.30) | 7 (4.17) | 0.127 |
| Calcium channel blockers, n (%) | 214 (33.23) | 57 (33.93) | 0.864 |
| Inotropes, n (%) | 66 (10.25) | 20 (11.90) | 0.540 |
| SGLT2I, n (%) | 110 (17.08) | 33 (19.64) | 0.442 |
| DOAC, n (%) | 236 (36.65) | 63 (37.50) | 0.838 |
| Antiplatelet, n (%) | 249 (38.66) | 47 (27.98) | 0.009 |
| ARNI, n (%) | 19 (2.95) | 2 (1.19) | 0.139 |
| Statin, n (%) | 282 (43.79) | 57 (33.93) | 0.020 |
[i] Data are presented as mean ± SD or n (%).
Abbreviations: ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blockers; ARNI, angiotensin receptor-neprilysin inhibitors; BNP, B-type natriuretic peptide; CONUT, Controlling Nutritional Status; DOAC, direct oral anticoagulants; GFR, glomerular filtration rate; HF, heart failure; IVST, interventricular septal thickness; LA, left atrial; LV, left ventricular; MRA, mineralocorticoid receptor antagonists; NYHA, New York Heart Association; PWT, posterior wall thickness; SGLT2I, sodium-glucose cotransporter 2 inhibitors; TAPSE, tricuspid annular plane systolic excursion; TRPG, tricuspid regurgitation pressure gradient.
Table 2
Patient characteristics after propensity score matching.
| NON-IMP | IMP | P VALUE | SMD | |
|---|---|---|---|---|
| n = 131 | n = 131 | |||
| Age, years | 71.40 ± 13.89 | 71.34 ± 14.02 | 0.968 | 0.004 |
| Female, n (%) | 74 (56.49) | 77 (58.78) | 0.708 | 0.046 |
| History of hospitalization of HF, n (%) | 50 (38.17) | 50 (38.17) | >0.99 | 0 |
| Hypertension, n (%) | 82 (62.60) | 84 (64.12) | 0.798 | 0.032 |
| Diabetes mellitus, n (%) | 48 (36.64) | 45 (34.35) | 0.699 | 0.048 |
| Dyslipidemia, n (%) | 40 (30.53) | 46 (35.11) | 0.43 | 0.098 |
| Hyperuricemia, n (%) | 37 (28.24) | 48 (36.64) | 0.146 | 0.180 |
| Chronic kidney disease, n (%) | 58 (44.27) | 55 (41.98) | 0.708 | 0.046 |
| Anemia, n (%) | 38 (29.01) | 39 (29.77) | 0.892 | 0.017 |
| Ischemic heart disease, n (%) | 45 (34.35) | 30 (22.90) | 0.040 | 0.255 |
| Atrial fibrillation, n (%) | 54 (41.22) | 66 (50.38) | 0.137 | 0.185 |
| BMI, kg/m2 | 23.33 ± 5.91 | 23.85 ± 4.80 | 0.061 | 0.097 |
| Systolic blood pressure, mm Hg | 133.36 ± 30.56 | 134.21 ± 33.88 | 0.830 | 0.026 |
| Diastolic blood pressure, mm Hg | 80.82 ± 21.88 | 81.28 ± 20.04 | 0.858 | 0.022 |
| Heart rate, bpm | 92.22 ± 25.27 | 90.47 ± 20.05 | 0.536 | 0.077 |
| NYHA3/4 | 123 (93.89) | 119 (90.83) | 0.385 | 0.098 |
| Dyspnea, n (%) | 116 (88.55) | 116 (88.55) | >0.99 | 0 |
| S3, n (%) | 32 (24.43) | 33 (25.19) | 0.886 | 0.018 |
| Rales, n (%) | 62 (47.33) | 51 (38.93) | 0.170 | 0.170 |
| Edema, n (%) | 93 (70.99) | 104 (79.39) | 0.115 | 0.195 |
| Anorexia, n (%) | 29 (22.14) | 31 (23.66) | 0.769 | 0.036 |
| medication on admission | ||||
| ACEI, n (%) | 21 (16.03) | 30 (22.90) | 0.159 | 0.174 |
| ARB, n (%) | 27 (20.61) | 30 (22.90) | 0.653 | 0.056 |
| Beta blockers, n (%) | 57 (43.51) | 63 (48.09) | 0.457 | 0.092 |
| MRA, n (%) | 39 (29.77) | 42 (32.06) | 0.688 | 0.050 |
| Loop diuretics, n (%) | 73 (55.73) | 80 (61.07) | 0.380 | 0.109 |
| Thiazides, n (%) | 3 (1.53) | 3 (2.29) | 0.651 | 0.056 |
| Tolvaptan, n (%) | 26 (19.85) | 23 (17.56) | 0.635 | 0.059 |
| Nitrates, n (%) | 8 (6.11) | 5 (3.82) | 0.391 | 0.106 |
| Calcium channel blockers, n (%) | 34 (25.95) | 45 (34.35) | 0.138 | 0.184 |
| Inotropes, n (%) | 11 (8.40) | 13 (9.92) | 0.668 | 0.053 |
| SGLT2I, n (%) | 7 (5.34) | 7 (5.34) | >0.99 | 0 |
| DOAC, n (%) | 23 (17.56) | 37 (28.24) | 0.039 | 0.256 |
| Antiplatelet, n (%) | 32 (24.43) | 25 (19.08) | 0.294 | 0.130 |
| ARNI, n (%) | 0 (0.0) | 0 (0.0) | ||
| Statin, n (%) | 33 (25.19) | 36 (27.48) | 0.674 | 0.052 |
| Laboratory data | ||||
| White blood cell, /μL | 7857.18 ± 3678.28 | 7059.06 ± 3005.53 | 0.056 | 0.238 |
| Lymphocyte, /μL | 1049.05 ± 917.28 | 871.18 ± 504.83 | 0.053 | 0.240 |
| Hemoglobin, g/dL | 11.62 ± 2.49 | 11.48 ± 2.25 | 0.633 | 0.059 |
| Hematocrit, % | 35.65 ± 7.23 | 35.16 ± 6.57 | 0.562 | 0.071 |
| Blood urea nitrogen, mg/dL | 29.18 ± 18.34 | 26.72 ± 15.81 | 0.246 | 0.144 |
| Creatinine, mg/dL | 1.523 ± 1.413 | 1.336 ± 0.944 | 0.208 | 0.156 |
| eGFR, mL/min/173 m2 | 47.76 ± 24.77 | 49.17 ± 21.69 | 0.623 | 0.061 |
| Uric acid, mg/dL | 7.113 ± 2.587 | 7.141 ± 2.792 | 0.934 | 0.010 |
| Sodium, mEq/L | 137.58 ± 6.16 | 138.55 ± 5.73 | 0.189 | 0.163 |
| Potassium, mEq/L | 4.23 ± 0.715 | 4.079 ± 0.631 | 0.080 | 0.224 |
| Chloride, mEq/L | 101.69 ± 6.228 | 102.96 ± 5.354 | 0.077 | 0.219 |
| Total protein, g/dL | 6.266 ± 0.786 | 6.270 ± 0.671 | 0.968 | 0.006 |
| Albumin, g/dL | 3.06 ± 0.44 | 3.24 ± 0.40 | 0.0007 | 0.428 |
| Total bilirubin, mg/dL | 1.132 ± 0.777 | 1.315 ± 1.179 | 0.140 | 0.183 |
| Total cholesterol, mg/dL | 142.96 ± 39.43 | 146.14 ± 31.16 | 0.481 | 0.090 |
| Triglycerides, mg/dL | 77.72 ± 38.34 | 79.50 ± 35.75 | 0.701 | 0.048 |
| HDL-cholesterol, mg/dL | 44.60 ± 15.87 | 47.24 ± 14.55 | 0.167 | 0.173 |
| LDL-cholesterol, mg/dL | 81.93 ± 31.59 | 81.46 ± 28.10 | 0.901 | 0.016 |
| BNP, pg/mL | 1176.74 ± 885.93 | 1085.41 ± 866.55 | 0.488 | 0.104 |
| NT-proBNP, pg/mL | 14663.2 ± 23288.03 | 6988.56 ± 5874.83 | 0.018 | 0.452 |
| CONUT score on admission | 6.37 ± 1.546 | 5.90 ± 1.246 | 0.0068 | 0.334 |
| CONUT score at discharge | 6.847 ± 1.605 | 3.550 ± 0.499 | <0.0001 | 2.774 |
| Echocardiography | ||||
| LV end-diastolic diameter, mm | 52.20 ± 10.35 | 52.36 ± 9.98 | 0.899 | 0.016 |
| LV systolic diameter, mm | 40.47 ± 12.36 | 40.73 ± 12.43 | 0.866 | 0.021 |
| LV ejection fraction, % | 44.21 ± 16.52 | 43.93 ± 16.86 | 0.894 | 0.017 |
| LA diameter, mm | 44.95 ± 9.26 | 45.35 ± 10.84 | 0.745 | 0.039 |
| LA volume, mL | 89.80 ± 52.09 | 104.75 ± 73.61 | 0.119 | 0.235 |
| IVST, mm | 9.99 ± 2.31 | 9.58 ± 2.09 | 0.132 | 0.186 |
| PWT, mm | 9.75 ± 1.97 | 9.82 ± 1.85 | 0.747 | 0.037 |
| E wave, cm/s | 86.18 ± 36.88 | 89.80 ± 36.79 | 0.439 | 0.098 |
| A wave, cm/s | 67.65 ± 30.10 | 66.88 ± 28.04 | 0.870 | 0.027 |
| TAPSE | 15.95 ± 4.51 | 15.68 ± 4.37 | 0.710 | 0.069 |
| TRPG, mm Hg | 28.40 ± 11.19 | 28.21 ± 13.38 | 0.902 | 0.015 |
| medication at discharge | ||||
| ACEI, n (%) | 54 (41.22) | 61 (46.56) | 0.383 | 0.108 |
| ARB, n (%) | 33 (25.19) | 37 (28.24) | 0.576 | 0.069 |
| Beta blockers, n (%) | 102 (77.86) | 105 (80.15) | 0.649 | 0.056 |
| MRA, n (%) | 82 (62.60) | 87 (66.41) | 0.519 | 0.080 |
| Loop diuretics, n (%) | 106 (80.92) | 113 (86.26) | 0.242 | 0.144 |
| Thiazides, n (%) | 4 (3.05) | 7 (5.34) | 0.353 | 0.114 |
| Tolvaptan, n (%) | 48 (36.64) | 45 (34.35) | 0.699 | 0.048 |
| Nitrates, n (%) | 8 (6.11) | 5 (3.82) | 0.391 | 0.106 |
| Calcium channel blockers, n (%) | 33 (25.19) | 49 (37.40) | 0.033 | 0.266 |
| Inotropes, n (%) | 20 (15.27) | 18 (13.74) | 0.726 | 0.043 |
| SGLT2I, n (%) | 20 (15.27) | 22 (16.79) | 0.736 | 0.041 |
| DOAC, n (%) | 37 (28.24) | 54 (41.22) | 0.027 | 0.275 |
| Antiplatelet, n (%) | 46 (35.11) | 35 (26.72) | 0.141 | 0.182 |
| ARNI, n (%) | 0 (0.0) | 2 (2.41) | 0.104 | 0.222 |
| Statin, n (%) | 45 (34.35) | 42 (32.06) | 0.694 | 0.049 |
[i] Data are presented as mean ± SD or n (%).
Abbreviations: ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blockers; ARNI, angiotensin receptor-neprilysin inhibitors; BNP, B-type natriuretic peptide; CONUT, Controlling Nutritional Status; DOAC, direct oral anticoagulants; GFR, glomerular filtration rate; HF, heart failure; IVST, interventricular septal thickness; LA, left atrial; LV, left ventricular; MRA, mineralocorticoid receptor antagonists; NYHA, New York Heart Association; PWT, posterior wall thickness; SGLT2I, sodium-glucose cotransporter 2 inhibitors; TAPSE, tricuspid annular plane systolic excursion; TRPG, tricuspid regurgitation pressure gradient.
Figure 1
Kaplan–Meier curves of primary and secondary endpoints before propensity matching. A. Kaplan–Meier survival curves of all-cause mortality in patients with heart failure according to group assignment. The IMP group is shown in blue and the Non-IMP group in red. B. Kaplan–Meier survival curves of composite endpoint (all-cause mortality or hospitalization for heart failure) in patients with heart failure according to group assignment. The IMP group is shown in blue and the Non-IMP group in red.
Figure 2
Kaplan–Meier curves of primary and secondary endpoints after propensity matching. A. Kaplan–Meier survival curves of all-cause mortality in patients with heart failure after propensity score matching. Survival curves are presented for the IMP group (blue line) and the Non-IMP group (red line). B. Kaplan–Meier survival curves of composite endpoint (all-cause mortality or hospitalization for heart failure) in patients with heart failure after propensity score matching. Survival curves are presented for the IMP group (blue line) and the Non-IMP group (red line).
Table 3
Multivariate logistic regression analysis for predictors of improvement in CONUT score.
| ODDS RATIO | 95% CI | P VALUE | ||
|---|---|---|---|---|
| Age, per 1-year increase | 1.036 | 0.957 | 1.151 | 0.429 |
| BMI, per 1-kg/m2 | 1.309 | 1.066 | 1.850 | 0.043 |
| Female | 0.453 | 0.033 | 4.082 | 0.500 |
| Loop diuretic at admission | 0.087 | 0.009 | 0.549 | 0.017 |
[i] Abbreviations: BMI, body mass index.
Table 4
Multivariate Cox proportional hazards model for all-cause mortality with overlap weighting.
| VARIABLES | HAZARD RATIO | 95% CI | P VALUE | |
|---|---|---|---|---|
| Age, per 1-year increase | 1.034 | 1.016 | 1.053 | 0.0002 |
| Improvement in the CONUT score | 0.357 | 0.205 | 0.624 | 0.0003 |
| Male | 1.470 | 0.969 | 2.229 | 0.070 |
| Log natriuretic peptide, per 1 log unit increase | 1.100 | 0.958 | 1.264 | 0.178 |
[i] Abbreviations: CONUT, Controlling Nutritional Status.