Mechanisms leading to malnutrition in chronic heart failure (CHF) are not fully understood. CHF is a condition characterised by systemic venous congestion. We hypothesised that malnutrition in CHF is related to right heart dysfunction and congestion which predispose to bowel oedema and malabsorption, thereby leading to malnutrition.Methods
We assessed malnutrition using the geriatric nutritional risk index (GNRI) and studied its association with congestion, assessed either clinically or by echocardiography, in a large cohort of patients referred to a community CHF clinic.Results
Of the 1058 patients enrolled, CHF was confirmed in 952 (69% males, median age 75(interquartile range (IQR):67–81) years, median NTproBNP 1141 (IQR: 465–2562) ng/L). 39% had HF with reduced (HeFREF, LVEF <40%) and 61% had HF with normal (HeFNEF, LVEF 40% and NTproBNP >125 ng/L) left ventricular ejection fraction.Results
Overall, 14% of patients were malnourished (GNRI 98). Clinical evidence of congestion, increasing right atrial pressure (RAP) and pulmonary artery pressure and right ventricular systolic dysfunction (RVSD) on echocardiography were associated with malnutrition. Addition of congestion variables to a model comprising of age and NTproBNP did not improve discrimination between malnourished and non-malnourished patients.Results
During a median follow-up of 1683 days (IQR: 1096–2230 days), 461 (44%) patients died. Malnutrition was an independent predictor of mortality. Patients who were malnourished with both RVSD and increased RAP had 6-fold increased risk of mortality compared to non-malnourished patients without RVSD and had normal RAP. (Figure)Conclusion
Malnutrition and congestion are modestly correlated and each is independently associated with increased mortality in patients with CHF.