Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation

Abstract

Background: Hospitalized patients with acute decompensated heart failure (ADHF) frequently exhibit aggravating mitral regurgitation (MR). Those patients do not always undergo surgical mitral valve repair, but particularly in the elderly, they are often treated by conservative medical therapy. This study was aimed to investigate factors affecting 6-month outcomes in hospitalized patients with heart failure (HF) harboring surgically untreated MR.Methods: We screened the presence of MR in hospitalized patients with HF between September 2017 and May 2020 in the Yamaguchi Prefectural Grand Medical (YPGM) center. At the time of discharge of these patients, individuals with surgically unoperated MR, including primary and secondary origin, were consequently recruited to this single-center prospective cohort study. The patients with severe MR who undergo surgical mitral valve treatment were not included in this study. The primary endpoint was all-cause readmission or all-cause death and the secondary endpoint was HF-related endpoint at 6 months after discharge. The Cox proportional hazard regression analyses were employed to assess the predictors for the composite endpoint.Results: Overall, 489 patients with ADHF were admitted to the YPGM center. Of those, 146 patients (30% of total patients with HF) (median age 83.5 years, 69 men) were identified as harboring grade II MR or greater. Consequently, all the recruited patients were diagnosed as functional MR. During a median follow-up of 186.0 days, a total of 55 patients (38%) reached the primary or secondary endpoints (HF death and readmission in 31 patients, other in 24 patients). As a result of multivariate analysis, geriatric nutritional risk index [hazard ratio (HR) = 0.932; 95% CI = 0.887–0.979, p = 0.005], age (HR = 1.058; 95% CI = 1.006–1.112, p = 0.027), and left ventricular ejection fraction (HR = 0.971; 95% CI = 0.945–0.997, p = 0.030) were independent predictors of all-cause death or all-cause admission. Body mass index (HR = 0.793; 95% CI = 0.614–0.890, p = 0.001) and ischemic heart disease etiology (HR = 2.732; 95% CI = 1.056–7.067, p = 0.038) were also independent predictors of the HF-related endpoints.Conclusion: Malnutrition and underweight were substantial predictors of adverse outcomes in elderly patients with HF harboring surgically untreated moderate-to-severe functional MR.

The impact of geriatric nutritional risk index on one-year outcomes in hospitalized elderly patients with heart failure

“…In the present study, therefore, we used the value of GNRI at discharge. Recent studies ( 42 , 52 ) have shown that GNRI at discharge is a more beneficial indicator of long-term prognosis than assessment at admission, which we believe supports our assessment methodology.…”

“…Although MNA-SF is considered a good indicator for outpatient ( 41 ), it is not suitable for accurate prediction during acute exacerbations of HF since body weight can change quickly due to systemic edema and congestion. In this regard, we expected that GNRI would be a good predictor in hospitalized patients, based on previous reports in hospitalized HFpEF patients and our previous report on its usefulness as a prognostic indicator in VHD patients ( 21 , 42 ). We found that the GNRI predicted all-cause mortality or HF hospitalization one year after discharge with high predictive accuracy.…”

Evaluation of Nutritional Status in an Acute Geriatric Unit: Retrospective Study and Analysis of Frailty Syndrome

“…Our work highlights the importance of measuring and evaluating undernutrition, as well as frailty syndrome, as they can predict negative events and an increase in morbidity and mortality. For example, a Japanese study in the context of managing heart failure found that malnutrition and underweight were significant predictors of adverse outcomes in elderly patients with heart failure and surgically untreated moderate-to-severe functional mitral regurgitation [ 23 ]. Frailty syndrome is also characterized by weight loss, a decline in functional abilities and physical strength, and geriatric consequences such as falls, protein-energy malnutrition, and memory problems.…”

Mortality prediction of the frailty syndrome in patients with severe mitral regurgitation

“…The authors described significantly higher hazards of death (hazard ratio: 3.06; p = 0.001) and death or heart failure decompensation (hazard ratio: 2.03; p = 0.007) in frail patients with severe MR undergoing TMVR compared to non-frail patients. Miura et al [19] found that malnutrition and frailty were predictors for adverse 6-month outcomes in hospitalized patients with heart failure and untreated mitral valve regurgitation and in patients with chronic heart failure (HF), while Yang et al [18] found 1.5-fold higher rates of mortality and incident hospitalization according to the frailty status. However, these results are not surprising, since HF and frailty share common clinical signs and symptoms, such as sarcopenia, cachexia, muscle weakness, reduced cardiac fitness, and increased inflammatory potential [18].…”