Heart failure (HF) is a major global health burden and a leading cause of morbidity and mortality. Nutritional status has emerged as an essential factor influencing outcomes in HF, with the Controlling Nutritional Status (CONUT) score gaining attention as a simple, objective marker derived from serum albumin, total cholesterol, and lymphocyte count. This meta-analysis evaluated the prognostic value of the CONUT score in predicting all-cause mortality in patients with acute and chronic heart failure. A systematic search was conducted in the PubMed, MEDLINE, Google Scholar, and Cochrane Library databases for the past ten years, using combinations of keywords such as “heart failure”, “CONUT score”, “malnutrition”, and “mortality”. Studies were included if they reported hazard ratios (HRs) for all-cause mortality in relation to CONUT score categories in adult HF populations. Eight eligible studies comprising 15,761 patients were included. Pooled analysis showed that higher CONUT scores were significantly associated with increased all-cause mortality (pooled HR = 1.47; 95% CI: 1.30–1.66). Despite substantial heterogeneity (I² = 80%), the direction of effect was consistent across studies. The CONUT score is a useful prognostic marker in acute and chronic heart failure patients. Further research should explore the effects of targeted nutritional interventions in high-risk HF patients identified by elevated CONUT scores and efforts to standardize malnutrition cut-offs in clinical practice.

Heart failure management remains a critical clinical challenge. While modern neurohormonal therapies have significantly improved survival, standard clinical assessments often fail to capture the full complexity of underlying structural disease progression. To comprehensively synthesize the established literature regarding the biological and prognostic roles of NT-proBNP, soluble ST2 (sST2), and Galectin-3 (Gal-3) and, subsequently, to propose a hypothesis-generating multimarker framework for HF risk stratification. A narrative review of the literature (2006–2026) was conducted across PubMed, Scopus, and Google Scholar. The synthesis focused on the clinical utility, phenotypic specificities, and methodological limitations of evaluating NT-proBNP, sST2, and Gal-3 concentrations. Evidence from the literature confirms that while NT-proBNP remains the gold standard for acute hemodynamic assessment. sST2 and Gal-3 provide complementary insights into active biomechanical strain and interstitial fibrotic remodeling; however, prospective randomized clinical trials demonstrating that sST2- or Gal-3-guided management improves clinical outcomes remain lacking. Based on these established findings, we propose an investigational four-step multimarker framework spanning from acute diagnosis to dynamic outpatient monitoring. This framework hypothesizes that integrating these pathways can better identify high-risk phenotypes that remain undetected by natriuretic peptides alone. The synergistic application of NT-proBNP, sST2, and Gal-3 offers a deeper pathophysiological evaluation of HF. However, our proposed biomarker-guided framework represents a set of testable research hypotheses. It requires prospective randomized validation before integration into routine clinical protocols for therapeutic titration.