Impact of malnutrition in patients with severe heart failure.
Advanced heart failure
Clinical outcomes
GNRI
Heart failure
Malnutrition
Severe heart failure
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
29 May 2024
29 May 2024
Historique:
revised:
10
03
2024
received:
18
01
2024
accepted:
29
04
2024
medline:
29
5
2024
pubmed:
29
5
2024
entrez:
29
5
2024
Statut:
aheadofprint
Résumé
The 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. Nutritional 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). In 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 European Society of Cardiology.
Références
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022;24:4–131. https://doi.org/10.1002/ejhf.2333
Tomasoni D, Vishram‐Nielsen JKK, Pagnesi M, Adamo M, Lombardi CM, Gustafsson F, et al. Advanced heart failure: Guideline‐directed medical therapy, diuretics, inotropes, and palliative care. ESC Heart Fail 2022;9:1507–1523. https://doi.org/10.1002/ehf2.13859
Lin H, Zhang H, Lin Z, Li X, Kong X, Sun G. Review of nutritional screening and assessment tools and clinical outcomes in heart failure. Heart Fail Rev 2016;21:549–565. https://doi.org/10.1007/s10741‐016‐9540‐0
Sze S, Pellicori P, Zhang J, Clark AL. Malnutrition, congestion and mortality in ambulatory patients with heart failure. Heart 2019;105:297–306. https://doi.org/10.1136/heartjnl‐2018‐313312
Driggin E, Cohen LP, Gallagher D, Karmally W, Maddox T, Hummel SL, et al. Nutrition assessment and dietary interventions in heart failure: JACC review topic of the week. J Am Coll Cardiol 2022;79:1623–1635. https://doi.org/10.1016/j.jacc.2022.02.025
Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36:49–64. https://doi.org/10.1016/j.clnu.2016.09.004
Berry C, Clark AL. Catabolism in chronic heart failure. Eur Heart J 2000;21:521–532. https://doi.org/10.1053/euhj.1999.1882
Rahman A, Jafry S, Jeejeebhoy K, Nagpal AD, Pisani B, Agarwala R. Malnutrition and cachexia in heart failure. JPEN J Parenter Enteral Nutr 2016;40:475–486. https://doi.org/10.1177/0148607114566854
Josiak K, Jankowska EA, Piepoli MF, Banasiak W, Ponikowski P. Skeletal myopathy in patients with chronic heart failure: Significance of anabolic‐androgenic hormones. J Cachexia Sarcopenia Muscle 2014;5:287–296. https://doi.org/10.1007/s13539‐014‐0152‐z
Bielecka‐Dabrowa A, Ebner N, dos Santos MR, Ishida J, Hasenfuss G, von Haehling S. Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail 2020;22:2314–2326. https://doi.org/10.1002/ejhf.2011
Esteban‐Fernández A, Villar‐Taibo R, Alejo M, Arroyo D, Bonilla Palomas JL, Cachero M, et al. Diagnosis and management of malnutrition in patients with heart failure. J Clin Med 2023;12:3320. https://doi.org/10.3390/jcm12093320
Sze S, Pellicori P, Kazmi S, Rigby A, Cleland JGF, Wong K, et al. Prevalence and prognostic significance of malnutrition using 3 scoring systems among outpatients with heart failure: A comparison with body mass index. JACC Heart Fail 2018;6:476–486. https://doi.org/10.1016/j.jchf.2018.02.018
Minamisawa M, Seidelmann SB, Claggett B, Hegde SM, Shah AM, Desai AS, et al. Impact of malnutrition using geriatric nutritional risk index in heart failure with preserved ejection fraction. JACC Heart Fail 2019;7:664–675. https://doi.org/10.1016/j.jchf.2019.04.020
Scotti A, Coisne A, Granada JF, Driggin E, Madhavan MV, Zhou Z, et al. Impact of malnutrition in patients with heart failure and secondary mitral regurgitation: The COAPT trial. J Am Coll Cardiol 2023;82:128–138. https://doi.org/10.1016/j.jacc.2023.04.047
Fernández‐Pombo A, Rodríguez‐Carnero G, Castro AI, Cantón‐Blanco A, Seoane LM, Casanueva FF, et al. Relevance of nutritional assessment and treatment to counteract cardiac cachexia and sarcopenia in chronic heart failure. Clin Nutr 2021;40:5141–5155. https://doi.org/10.1016/j.clnu.2021.07.027
Pagnesi M, Lombardi CM, Chiarito M, Stolfo D, Baldetti L, Loiacono F, et al. Prognostic impact of the updated 2018 HFA‐ESC definition of advanced heart failure: Results from the HELP‐HF registry. Eur J Heart Fail 2022;24:1493–1503. https://doi.org/10.1002/ejhf.2561
Pagnesi M, Ghiraldin D, Vizzardi E, Chiarito M, Stolfo D, Baldetti L, et al. Detailed assessment of the “I Need Help” criteria in patients with heart failure: Insights from the HELP‐HF registry. Circ Heart Fail 2023;16:e011003. https://doi.org/10.1161/CIRCHEARTFAILURE.123.011003
Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric nutritional risk index: a new index for evaluating at‐risk elderly medical patients 1–3. Am J Clin Nutr 2005;82:777–783. https://doi.org/10.1093/ajcn/82.4.777
Cereda E, Pedrolli C. The geriatric nutritional risk index. Curr Opin Clin Nutr Metab Care 2009;12:1–7. https://doi.org/10.1097/MCO.0b013e3283186f59
Pagnesi M, Lombardi CM, Tedino C, Chiarito M, Stolfo D, Baldetti L, et al. Role of ejection fraction in patients at risk for advanced heart failure: Insights from the HELP‐HF registry. ESC Heart Fail 2024;11:136–146. https://doi.org/10.1002/ehf2.14539
Tomasoni D, Pagnesi M, Colombo G, Chiarito M, Stolfo D, Baldetti L, et al. Guideline‐directed medical therapy in severe heart failure with reduced ejection fraction: An analysis from the HELP‐HF registry. Eur J Heart Fail 2024;26:327–337. https://doi.org/10.1002/ejhf.3081
Kalantar‐Zadeh K, Anker SD, Horwich TB, Fonarow GC. Nutritional and anti‐inflammatory interventions in chronic heart failure. Am J Cardiol 2008;101:S89–S103. https://doi.org/10.1016/j.amjcard.2008.03.007
Kenchaiah S, Pocock SJ, Wang D, Finn PV, Zornoff LAM, Skali H, et al. Body mass index and prognosis in patients with chronic heart failure: Insights from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation 2007;116:627–636. https://doi.org/10.1161/CIRCULATIONAHA.106.679779
Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F, et al. The obesity paradox: Body mass index and outcomes in patients with heart failure. Arch Intern Med 2005;165:55–61. https://doi.org/10.1001/archinte.165.1.55
Thanapholsart J, Khan E, Lee GA. A current review of the uses of bioelectrical impedance analysis and bioelectrical impedance vector analysis in acute and chronic heart failure patients: An under‐valued resource? Biol Res Nurs 2023;25:240–249. https://doi.org/10.1177/10998004221132838
Booth J, Pinney J, Davenport A. N‐terminal proBNP—Marker of cardiac dysfunction, fluid overload, or malnutrition in hemodialysis patients? Clin J Am Soc Nephrol 2010;5:1036–1040. https://doi.org/10.2215/cjn.09001209
Bednarek‐Skublewska A, Zaluska W, Ksiazek A. The relationship between serum level of N‐terminal pro‐B‐type natriuretic peptide and nutritional status, and inflammation in chronic hemodialysis patients. Clin Nephrol 2010;73:14–20. https://doi.org/10.5414/cnp73014
Nakayama Y, Yamada Y, Ishii S, Hitaka M, Yamazaki K, Masai M, et al. Association between intra‐ and extra‐cellular water ratio imbalance and natriuretic peptides in patients undergoing hemodialysis. Nutrients 2023;15:1274. https://doi.org/10.3390/nu15051274
Ducros J, Larifla L, Merault H, Galantine V, Bassien‐Capsa V, Foucan L. N‐terminal pro‐B‐type natriuretic peptide and malnutrition in patients on hemodialysis. Int J Nephrol 2020;2020:9528014. https://doi.org/10.1155/2020/9528014
Madelaire C, Gustafsson F, Kristensen SL, D'Souza M, Stevenson LW, Kober L, et al. Burden and causes of hospital admissions in heart failure during the last year of life. JACC Heart Fail 2019;7:561–570. https://doi.org/10.1016/j.jchf.2019.03.018
Platz E, Jhund PS, Claggett BL, Pfeffer MA, Swedberg K, Granger CB, et al. Prevalence and prognostic importance of precipitating factors leading to heart failure hospitalization: Recurrent hospitalizations and mortality. Eur J Heart Fail 2018;20:295–303. https://doi.org/10.1002/ejhf.901