Prediction of all-cause mortality with malnutrition assessed by nutritional screening and assessment tools in patients with heart failure：a systematic review

Hu, Yule; Yang, Huazhong; Yanjun, Zhou; Liu, Xin; Zou, Changhong; Ji, Shiming; Liang, Tao

doi:10.1016/j.numecd.2022.03.009

Cited by 24 publications

(12 citation statements)

References 52 publications

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“…Except for the CONUT score, some other simple nutritional indexes had also been proposed in patients with HF ( 8 ). For example, the prognostic nutritional index (PNI), which was calculated from the serum albumin and total peripheral lymphocyte count, was reported to be associated with a poor prognosis in patients with acute and chronic HF ( 46 , 47 ).…”

Section: Discussionmentioning

confidence: 99%

“…Early detection of malnutrition in HF would be useful for identifying patients at high risk of poor clinical outcomes and recommending nutritional interventions to improve prognosis (7). Many tools and indexes had been proposed for screening malnutrition; however, no consensus had been made on which to use in patients with HF (5,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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The controlling nutritional status score and clinical outcomes in patients with heart failure: Pool analysis of observational studies

Huang

Luo

Baldinger

2022

Front. Cardiovasc. Med.

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Background and aimsMalnutrition is very common in patients with heart failure (HF) and is associated with a worse clinical outcome. The Controlling Nutritional Status (CONUT) score is an easily derived index for the evaluation of malnutrition. This study aimed to evaluate the association between the CONUT score and the prognosis in patients with HF.Methods and resultsElectronic databases were searched for potential studies from inception up to February 15, 2022. Observational cohort studies included adult participants with HF, and reported the associations between the CONUT score and the adjusted relative risk (RR) of all-cause mortality, and patients with composite major adverse cardiac outcomes (MACEs) were included. We finally included 18 studies comprising 12,532 participants with HF for analysis. The median age of the patients was 70.5 years old, and 35.4% were women. After a median follow-up duration of 32.5 months, patients with HF with a higher CONUT score were associated with a higher risk of all-cause mortality (per 1 increment of the CONUT score: RR, 1.21, 95% CI, 1.13–1.29, I2 = 68%, P for heterogeneity = 0.002) and MACEs (per 1 increment of the CONUT score: RR, 1.14, 95% CI, 1.06–1.23, I2 = 81%, P for heterogeneity <0.0001) after adjusting for other prognostic factors. When the CONUT score was divided into the normal nutritional status and malnourished status, malnourished patients with HF were associated with increased risks of all-cause death (RR, 1.61, 95% CI, 1.40–1.85, I2 = 17%, P for heterogeneity = 0.29) and MACEs (RR, 2.12, 95% CI, 1.49–3.02, I2 = 87%, P for heterogeneity <0.0001), compared with those with normal nutritional status.ConclusionsThe CONUT score is associated with the clinical outcomes in patients with HF, and can be used as a screening tool of nutritional status in HF to improve prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The controlling nutritional status score and clinical outcomes in patients with heart failure: Pool analysis of observational studies

Huang

Luo

Baldinger

2022

Front. Cardiovasc. Med.

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“…For risk stratification and prognostic prediction in physical frailty of patients with HF, a multicenter prospective cohort of 2721 patients (median age: 76 [interquartile range [67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83] years, men: 60.5%) who were ambulatory at discharge was used. The FLAGSHIP study is instructive: usual walking speed of <0.98 m/s, 4 points; grip strength of <30.0 kg (men) or 17.5 kg (women), 5 points; PMADL-8 of ≥21, 2 points; SEW-7 of ≤20, 3 points and assigned a cutoff value and score for each indicator.…”

Section: Prevalence and Diagnosismentioning

confidence: 99%

“…In a systematic review that evaluated the prediction of all-cause mortality in HF using nutrition tools other than GLIM, HRs for all-cause mortality were MNA (HR = 2.62, 95% CI 1.11-6.20, P = 0.03] and MNA-SF (HR = 1.94, 95% CI 1.40-2.70, P < 0.001) were reported to be the best. 76 Among them, the GLIM criteria, released in 2018, are the world's first international criteria for diagnosing undernutrition, with four societies from Europe, the United States, Asia, and South America participating in their development, and are an evaluation index for evaluation. Compared to the widely used GNRI, the GLIM criteria are partly recommended because they do not include Nutritional therapy for patients with HF is not yet well established, and even the 2020 meta-analysis reported a few valid articles.…”

Section: Nutritional Interventionmentioning

confidence: 99%

Clinical Perspectives on Cardiac Rehabilitation After Heart Failure in Elderly Patients with Frailty: A Narrative Review

Tsukakoshi¹,

Yamamoto²,

Takeda³

et al. 2022

TCRM

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The purpose of this narrative review is to examine rehabilitation modalities for patients with heart failure and Frailty who require comprehensive intervention. Ischemic heart disease is the leading cause of death worldwide, accounting for 16% of global mortality. Due to population growing and aging, the total number of heart failure patients continues to rise, a condition known as the heart failure pandemic. Furthermore, frailty has been associated with an increased risk for heart failure and increased morbidity and mortality. The 2021 update of the 2017 ACC expert consensus decision pathway for optimization of HF treatment has become more concerning, citing frailty as one of the 10 most important issues associated with heart failure with reduced ejection fraction (HFrEF). Frailty and heart failure share common pathological mechanisms and are associated with poor clinical outcomes. Most studies of frailty in patients with heart failure primarily focus on physical frailty, and associations between psycho-psychological and social factors such as cognitive dysfunction and social isolation have also been reported. These results suggest that a more comprehensive assessment of frailty is important to determine the risk in patients with heart failure. Therefore, mechanisms of the three domains, including not only physical frailty but also cognitive, psychological, spiritual, and social aspects, should be understood. In addition to interventions in these three domains, nutritional and pharmacological interventions are also important and require tailor-made interventions for the widely varied conditions associated with heart failure and frailty. Although several studies have shown a relationship between frailty and prognosis in patients with heart failure, interventions to improve the prognosis have not yet been established. Further information is needed on frailty intervention by a multidisciplinary team to improve the prognosis.

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“…Malnutrition is an important prognostic factor in HF. It was estimated that up to 50% of patients with HF were malnourished (10). Current guidelines for the management of HF recommend assessment of nutritional status in chronic HF (3,11); however, there is no consensus on the tools or metrics for measuring malnutrition.…”

Section: Introductionmentioning

confidence: 99%

Association Between Prognostic Nutritional Index and Prognosis in Patients With Heart Failure: A Meta-Analysis

Chen

Wen

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe prognostic nutritional index (PNI) has been proposed as a marker of malnutrition and associated with the prognosis of cardiovascular disease. However, whether PNI can serve as a potential biomarker for the prognosis of heart failure (HF) upon those established risk factors were still controversial. This meta-analysis aimed to generate comprehensive evidence on the prognostic value of PNI in patients with HF.MethodsMultiple databases (PubMed, Embase, the Cochrane Library, and Google Scholar) were searched for related studies up to January 31, 2022. Observational studies accessed associations between PNI levels and the prognosis in patients with HF were included for meta-analysis. The hazard ratios (HRs) and 95% confidence intervals (CI) were calculated.ResultsFourteen studies, comprising 19,605 patients with HF were included for meta-analysis. The median follow-up duration was 18.5 months. Compared with those with higher PNI (normal nutritional status), patients with HF with lower PNI (malnourished) were associated with a higher risk of all-cause mortality (HR 1.53, 95% CI 1.27–1.85) and composite major adverse cardiac outcomes (MACEs; HR 2.26, 95% CI 1.54–3.31) in the multivariable-adjusted model. Furthermore, when PNI was defined as per 1 increment as a continuous metric, higher PNI was associated with a decrease in all-cause mortality (per 1 increment of PNI: HR 0.94, 95% CI 0.88–0.96) and MACEs (per 1 increment of PNI: HR 0.97, 95% CI 0.95–0.98).ConclusionsThe PNI can serve as an easily calculated bedside “malnutrition-inflammation” biomarker in HF. Lower PNI was associated with a worse prognosis in patients with HF.

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Prediction of all-cause mortality with malnutrition assessed by nutritional screening and assessment tools in patients with heart failure：a systematic review

Cited by 24 publications

References 52 publications

The controlling nutritional status score and clinical outcomes in patients with heart failure: Pool analysis of observational studies

The controlling nutritional status score and clinical outcomes in patients with heart failure: Pool analysis of observational studies

Clinical Perspectives on Cardiac Rehabilitation After Heart Failure in Elderly Patients with Frailty: A Narrative Review

Association Between Prognostic Nutritional Index and Prognosis in Patients With Heart Failure: A Meta-Analysis

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