Impact of malnutrition in the embolic–haemorrhagic trade-off of elderly patients with atrial fibrillation

Abstract

Aims Nutrition is an important determinant of health above the age of 80 years. Malnutrition in the elderly is often underdiagnosed. The aim of this study was to report the prevalence and prognostic value of malnutrition in patients ≥80 years old with atrial fibrillation (AF) with and without anticoagulant therapy. Methods and results We assessed the nutritional status of 4724 octogenarian patients with diagnoses of AF in a single centre from Spain between 2014 and 2017 with the CONUT score. Malnutrition was confirmed in 2036 patients (43.1%). Anticoagulation prescription was more frequent in patients with good nutrition than in those malnourished (79.5% vs. 71.7%, P < 0.001). The impact of malnutrition on mortality was evaluated by Cox regression, whereas its association with ischaemic stroke and major bleeding was studied through competing risk analysis. After multivariate adjusting, malnutrition was associated with mortality [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.24–1.49], stroke [sub-distribution HR (sHR) 1.37, 95% CI 1.10–1.69], and major bleeding (sHR 1.29, 95% CI 1.02–1.64). In anticoagulated patients, the embolic–haemorrhagic trade-off event was virtually neutral for those who had normal nutritional status [average daily rates (ADRs) for stroke and bleeding: 4.70 and 4.69 per 100 000 patients/day, respectively; difference = +0.01 per 100 000 patients/day; P = 0.99] and negative for those with malnutrition (ADR for stroke and bleeding: 5.38 and 7.61 per 100 000 patients/day, respectively; difference = −2.23 per 100 000 patients/day; P = 0.07). Conclusion Malnutrition is very common in octogenarian patients with AF, being a clinical predictor for poor prognosis. For anticoagulated patients, malnutrition was associated with a negative embolic–haemorrhagic balance.

Potential role of the geriatric nutritional risk index as a novel risk factor for the development of non-valvular atrial fibrillation in patients with heart failure

“…One recent study provides relevant clinical information on a topic scarcely studied to date, i.e., on the impact of nutritional status on patients with AF. In this study, they report the following main fi ndings: (i) almost half of patients with AF, aged >80 years have some degree of malnutrition; (ii) malnutrition in patients with AF is independently associated with an increased risk of death, ischemic stroke, and major bleeding (20). Our study investigating the risk of developing NVAF in elder HF patients with low GNRI is one of the fi rst researches in this area.…”

Malnutrition and Risk of Procedural Complications in Patients With Atrial Fibrillation Undergoing Catheter Ablation

“…A diagnosis of malnutrition was reached using the CONUT score, which is a screening tool for the nutritional status of hospitalized patients ( 18 ) and was calculated according to the levels of serum albumin, cholesterol, and total lymphocyte count ( Table 1 ). High CONUT score has been known to have a prognostic impact in patients with chronic cardiac disease including heart failure and AF ( 6 , 14 ). Also, the score has been associated with outcomes after cardiovascular surgery ( 19 ) or interventional procedures including transcatheter aortic valve replacement and percutaneous coronary intervention ( 20 , 21 ).…”

“…AFCA has been found to be associated with a lower risk of mortality and hospitalizations for heart failure ( 10 ), a lower risk of stroke ( 11 ), and improved cognitive function ( 12 , 13 ). Among the various screening tools for malnutrition, controlling the nutritional status (CONUT) score has been studied in AF ( 14 , 15 ). Malnutrition determined by this score is an independent predictor of a poor prognosis, especially hemorrhagic adverse events and AF recurrence after AFCA ( 14 , 15 ).…”

“…Among the various screening tools for malnutrition, controlling the nutritional status (CONUT) score has been studied in AF ( 14 , 15 ). Malnutrition determined by this score is an independent predictor of a poor prognosis, especially hemorrhagic adverse events and AF recurrence after AFCA ( 14 , 15 ). However, few studies have evaluated the effect of nutritional status on the outcomes of AFCA, and the relationship between the nutritional status and safety of AFCA remains unclear.…”

Predicting One-Year Deaths and Major Adverse Vascular Events with the Controlling Nutritional Status Score in Elderly Patients with Non–ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…Recently, it has been reported that malnutrition is associated with the development of atherosclerosis and a greater incidence of cardiovascular mortality in elderly patients [ 5 ]. It has also been shown to be an important prognostic factor for several cardiovascular diseases (CVDs), such as heart failure, hypertension, valvular heart disease and atrial fibrillation [ 6 , 7 , 8 , 9 , 10 ]. Although malnutrition has also been studied in patients with ACS, these studies largely included either ST-elevated myocardial infarction (MI) (STEMI) patients who underwent primary percutaneous coronary intervention (PCI) or heterogeneous ACS cohorts [ 11 , 12 ].…”