Association between prognostic nutritional index and major adverse cardiovascular events in patients with atrial fibrillation combined with heart failure with preserved ejection fraction.

Using the optimal cutoff value (42.95), higher PNI remained protective, with HRs of 0.222 (95% CI: 0.103–0.478), 0.248 (95% CI: 0.115–0.535), and 0.258 (95% CI: 0.120–0.557), all highly significant ( P ≤ 0.001).

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Subgroup analyses generally supported the direction of the association across most clinical strata, although certain subgroups did not reach statistical significance and the findings should be interpreted as exploratory.

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