Diagnosis and Management of Malnutrition in Patients with Heart Failure

Esteban-Fernández, Alberto; Villar-Taibo, Rocío; Alejo, Mirian; Arroyo, David; Bonilla Palomas, Juan Luis; Cachero, Montserrat; Joaquin, Clara; Méndez Bailón, Manuel; Pérez-Rivera, José Ángel; Romero-Vigara, Juan Carlos; Somoza, Gema

doi:10.3390/jcm12093320

Cited by 16 publications

(4 citation statements)

References 110 publications

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“…Malnutrition and sarcopenia are very common in frail patients with heart failure [18], and also in this population, we identified the coexistence of poor nutritional status (according to the MNA) and of significant sarcopenia (as assessed by the hand grip test) [19]. The presence of malnutrition status and sarcopenia is also supported by lower values of proteins as well as of serum albumin and CPK and by a chronic status of inflammation, expressed by a significant increment in CRP and neutrophil values [20]. The compromised cardiovascular picture post AHF is confirmed by increased levels of BNP, troponin I, and creatinine in these patients.…”

Section: Clinical Surgical and Geriatric Features In Ahf Patientsmentioning

confidence: 83%

The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction

Esposito,

Foffa,

Vecoli

et al. 2024

JCDD

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Frailty degree plays a critical role in the decision-making and outcomes of elderly patients with severe aortic stenosis (AS). Acute heart failure (AHF) results in a severely worse clinical hemodynamic status in this population. This study aimed to evaluate the impact of AHF on frailty degree and outcomes in older patients referred for tailored interventional treatment due to AS. A total of 109 patients (68% female; mean age 83.3 ± 5.4), evaluated by a multidisciplinary path for “frailty-based management” of valve disease, were divided into two groups, one with (AHF+) and one without AHF (AHF-) and preserved ejection fraction (mean value EF: 57.4 ± 8.6). AHF occurred a mean value of 55 days before geriatric, clinical, and surgical assessment. A follow-up for all-cause mortality and readmission was conducted at 20 months. AHF+ patients showed a higher frequency of advanced frailty (53.3% vs. 46.7%, respectively), rehospitalization (35.5% vs. 12.8; p = 0.007), and death (41.9% vs. 12.8%; p < 0.001). In stepwise logistic regression analysis, AHF emerged as an independent risk factor for advanced frailty (OR: 3.8 CI 1.3–10.7; p = 0.01) and hospital readmission (OR: 3.6 CI 1.1–11.6; p = 0.03). In addition, preceding AHF was an independent determinant associated with a higher risk of mortality (HR 2.65; CI 95% 1.04–6.74; p-value 0.04). AHF is independently associated with advanced frailty and poor outcomes in elderly patients with severe AS. So, this population needs careful clinical and geriatric monitoring and the implementation of interventional therapy for AS in the early stages of frailty to avoid the occurrence of AHF and poor outcomes.

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Section: Clinical Surgical and Geriatric Features In Ahf Patientsmentioning

confidence: 83%

The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction

Esposito,

Foffa,

Vecoli

et al. 2024

JCDD

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“…NT-proBNP >5775 pg/ml or BNP >685 pg/ml) may help identifying those patients at risk of malnutrition, likely accompanied by cardiac cachexia (malnutrition/cachexia complex). 5,8,10,11 Although the negative prognostic impact of malnutrition in patients with HF has been already demonstrated, 4,5,[11][12][13] the evidence in the specific setting of severe HF is limited. In this study, we demonstrated that malnutrition, defined as GNRI ≤98, was independently associated with higher mortality in a contemporary, real-world population of patients with HF and at least one high-risk marker for advanced HF.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] Malnutrition has been associated with adverse outcomes in HF, including a higher risk of mortality. [11][12][13][14] However, most studies focused on unselected HF populations, whereas the incidence and impact of malnutrition might be particularly relevant in the advanced HF setting.…”

Section: Introductionmentioning

confidence: 99%

Impact of malnutrition in patients with severe heart failure

Pagnesi,

Serafini,

Chiarito

et al. 2024

European J of Heart Fail

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AimThe role of malnutrition among patients with severe heart failure (HF) is not well established. We evaluated the incidence, predictors, and prognostic impact of malnutrition in patients with severe HF.Methods and resultsNutritional status was measured using the geriatric nutritional risk index (GNRI), based on body weight, height and serum albumin concentration, with malnutrition defined as GNRI ≤98. It was assessed in consecutive patients with severe HF, defined by at least one high‐risk ‘I NEED HELP’ marker, enrolled at four Italian centres between January 2020 and November 2021. The primary endpoint was all‐cause mortality. A total of 510 patients with data regarding nutritional status were included in the study (mean age 74 ± 12 years, 66.5% male). Among them, 179 (35.1%) had GNRI ≤98 (malnutrition). At multivariable logistic regression, lower body mass index (BMI) and higher levels of natriuretic peptides (B‐type natriuretic peptide [BNP] > median value [685 pg/ml] or N‐terminal proBNP > median value [5775 pg/ml]) were independently associated with a higher likelihood of malnutrition. Estimated rates of all‐cause death at 1 year were 22.4% and 41.1% in patients without and with malnutrition, respectively (log‐rank p < 0.001). The impact of malnutrition on all‐cause mortality was confirmed after multivariable adjustment for relevant covariates (adjusted hazard ratio 2.03, 95% confidence interval 1.43–2.89, p < 0.001).ConclusionIn a contemporary, real‐world, multicentre cohort of patients with severe HF, malnutrition (defined as GNRI ≤98) was common and independently associated with an increased risk of mortality. Lower BMI and higher natriuretic peptides were identified as predictors of malnutrition in these patients.

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“…For these reasons, it is recommended to use multidimensional tools that allow a global assessment of nutritional statuses, such as the Mini Nutritional Assessment (MNA), which assesses dietary intake, mobility, and BMI [68]. According to MNA, patients are classified according to the score in normal nutritional state (12-14 points), malnutrition risk (8-11 points), and malnutrition (0-7 points).…”

Section: Which Tools Do We Have To Evaluate Nutritional Status In Pat...mentioning

confidence: 99%

Practical Approaches to the Management of Cardiorenal Disease Beyond Congestion

Blazquez-Bermejo,

Quiroga,

Casado

et al. 2024

Cardiorenal Med

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The coexistence of heart and kidney diseases, also called cardiorenal syndrome, is increasingly common, leads to a significant impact on morbidity and mortality, and poses diagnostic and therapeutic difficulties. There is a risk-treatment paradox, such that patients with the highest risk are treated with lesser disease-modifying medical therapies. In this document, different scientific societies propose a practical approach to systematically address and optimize cardiorenal therapies and related comorbidities in chronic cardiorenal disease beyond congestion. Cardiorenal programs have emerged as novel models that may assist in delivering coordinated and holistic management for these patients.

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Diagnosis and Management of Malnutrition in Patients with Heart Failure

Cited by 16 publications

References 110 publications

The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction

The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction

Impact of malnutrition in patients with severe heart failure

Practical Approaches to the Management of Cardiorenal Disease Beyond Congestion

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