Energy intake during hospital stay predicts all-cause mortality after discharge independently of nutritional status in elderly heart failure patients

Abstract

Objective Malnutrition is associated with an increased risk of mortality in heart failure (HF) patients. Here, we examined the hypothesis that assessment of energy intake in addition to nutritional status improves the stratification of mortality risk in elderly HF patients. Methods We retrospectively examined 419 HF patients aged ≥ 65 years (median 78 years, 49% female). Nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF), and daily energy intake was calculated from intake during 3 consecutive days before discharge. Results During a median 1.52-year period (IQR 0.96–2.94 years), 110 patients (26%) died. Kaplan–Meier survival curves showed that patients with low tertile of daily energy intake had a higher mortality rate than did patients with high or middle tertile of daily energy intake. In multivariate Cox regression analyses, low daily energy intake was independently associated with higher mortality after adjustment for the model including age, sex, BNP, Charlson Comorbidity Index, history of HF hospitalization, and cachexia in addition to MNA-SF. Inclusion of both MNA-SF and energy intake into the adjustment model improved the accuracy of prediction of the mortality after discharge (continuous net reclassification improvement, 0.355, p = 0.003; integrated discrimination improvement, 0.029, p = 0.003). Results of a fully adjusted dose-dependent association analysis showed that risk of all-cause mortality was lowest among HF patients who consumed 31.5 kcal/kg/day of energy. Conclusions Energy intake during hospital stay is an independent predictor of the mortality in elderly HF patients, and its assessment together with established predictors improves the mortality risk stratification. Graphic abstract

Barthel Index Score Predicts Mortality in Elderly Heart Failure ― A Goal of Comprehensive Cardiac Rehabilitation ―

“…Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) within 3 days before discharge, as described previously. 23,24 The MNA-SF consists of 6 questions about reductions in food intake over the past 3 months, weight loss during the past 3 months, mobility, psychological stress or acute disease in the past 3 months, neuropsychological problems, and body mass index (BMI) and it is scored from 0 to 14.…”

“…Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/ 1.73 m 2 . 24 Transthoracic echocardiography was performed by the standard protocol, and the left ventricular ejection fraction (LVEF) was measured by the modified Simpson method. HF with reduced ejection fraction (HFrEF) was defined as LVEF <40%.…”

“…25 Comorbidities were assessed using the Charlson Comorbidity Index (CCI), as described previously. 24,26…”

“…Harrell's C-index was calculated and compared between the base model and the model with the addition of the BI score. 24 Furthermore, to examine the significance of the incremental discriminative value added by the BI score, the log-likelihood ratio (LLR), continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI) were calculated. 24 Two-tailed P<0.05 was considered statistically significant.…”

“…24 Furthermore, to examine the significance of the incremental discriminative value added by the BI score, the log-likelihood ratio (LLR), continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI) were calculated. 24 Two-tailed P<0.05 was considered statistically significant. Statistical analyses were performed using JMP Pro version 15.2.1 (SAS Institute, Cary, NC, USA) and R version 3.6.2 (R Foundation for Statistical Computing, Vienna, Austria).…”