6 Prognostic value of malnutrition screening tools in patients with chronic heart failure

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BackgroundMalnutrition is a common clinical feature in patients with acute heart failure (AHF), but its prevalence and clinical impact on morbidity and mortality of patients with chronic HF (CHF) remains to be determined.PurposeTo evaluate the prevalence, clinical associations and prognostic value of three different malnutrition indices in a large cohort of patients referred to a community HF clinic with suspected HF.MethodsConsecutive referrals were analysed. HF was defined as signs or symptoms and evidence of cardiac dysfunction, either a reduced left ventricular ejection fraction at echocardiography (LVEF, <50%) or raised NTproBNP (>125 ng/L). Patients were screened for malnutrition using three common malnutrition indices: the geriatric nutritional risk index (GNRI), the controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI).ResultsOf the 5012 patients who attended between 2000 and 2016, HF was confirmed in 3386 (61% males, median age 75 (interquartile range (IQR): 67–81) years, median NTproBNP 1573 (IQR: 702–2799) ng/L). Of these, 1198 (35%) and 1458 (43%) patients had HF with reduced (HeFREF, LVEF<40%) and normal (HeFNEF, LVEF 50%) ejection fraction, respectively. According to the GNRI (91%), CONUT score (>4) and PNI (38%), 6.7%, 10.0% and 7.5% patients were moderately to severely malnourished, respectively.Compared to those with normal nutritional status, malnourished patients were older, had lower body mass index (BMI), worse symptoms and renal function; they were also more likely to have atrial fibrillation, anaemia and reduced mobility.During a median follow-up of 1573 days (interquartile range: 702–2799 days), 1723 (50.9%) patients died. In multivariable models, indices of malnutrition were powerful predictors of mortality. In a multivariable model that included all the malnutrition indices, only GNRI was independently associated with increased risk of mortality (Hazard ratio (95% confidence interval): 1.25 (1.12–1.39), p<0.001 for worsening malnutrition category of GNRI).ConclusionModerate or severe malnutrition is highly prevalent amongst patients with CHF and is strongly related to mortality.

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