Nutritional status is related to heart failure severity and hospital readmissions in acute heart failure

Bermejo, Rosa María Agra; González‐Ferreiro, Rocío; Román, Alfonso Varela; Otero, Iago; Kreidieh, Omar; Sabarís, Patricia Conde; Rodríguez‐Mañero, Moisés; González, María Moure; Blanco, Ana Seoane; Lamela, Alejandro Virgós; Castelo, Alberto García; González-Juanatey, José Ramón

doi:10.1016/j.ijcard.2016.12.067

Cited by 76 publications

(71 citation statements)

References 39 publications

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“…Our results showed that all-cause death occurred more frequently in HFpEF patients with moderate or major nutrition-related risk than in those with low or no nutrition-related risk ( Table 3 and Model 4). [7][8][9][10][11][12][13][14][15][16][17][18][19][20] However, to our knowledge, all but one 18 of the previous studies reported on so-called HF patients, and therefore, our specific findings for 'HFpEF patients' are novel. The results of the present study indicate that screening nutritional status using a GNRI at discharge further refines risk assessment in patients hospitalized with HFpEF.…”

Section: Discussionmentioning

confidence: 76%

“…In HF patients, undernutrition is not uncommon [7][8][9][10][11][12][13][14][15] and represents one of the most significant determinants of poor clinical outcomes. [7][8][9][10][11][12][13][14][15][16][17] The geriatric nutritional risk index (GNRI) is a simple and well-established nutritional screening tool for elderly HF patients. [18][19][20] However, the predictive value of the assessment of nutritional status using GNRI in patients with HFpEF remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

et al. 2019

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Aims The objective of the study was to evaluate whether the geriatric nutritional risk index (GNRI) at discharge may be helpful in predicting the long‐term prognosis of patients hospitalized with heart failure (HF) with preserved ejection fraction (HFpEF, left ventricular ejection fraction ≥50%), a common HF phenotype in the elderly. Methods and results Overall, 110 elderly HFpEF patients (≥65 years) from the Ibaraki Cardiovascular Assessment Study‐HF ( n = 838) were enrolled. The mean age was 78.5 ± 7.2 years, and male patients accounted for 53.6% ( n = 59). All‐cause mortality was compared between the low GNRI (<92) with moderate or severe nutritional risk group and the high GNRI (≥92) with no or low nutritional risk group. Cox proportional hazard regression models were constructed to evaluate the influence of the GNRI on all‐cause death with the following covariates using forward stepwise selection: age, sex, nutritional status based on the GNRI as a categorical variable, history of HF hospitalization, haemoglobin level, estimated glomerular filtration rate, log brain natriuretic peptide levels (logBNP), history of hypertension, log C‐reactive protein levels, left ventricular ejection fraction, left ventricular mass index, and the New York Heart Association functional classification (I/II or III class). The prognostic value of the GNRI was compared with that of serum albumin using C‐statistics. The GNRI was added to the logBNP, serum albumin or the body mass index was added to the logBNP, and the C‐statistic was compared using DeLong's test. Cox regression analysis revealed that age and a low GNRI were independent predictors of all‐cause death ( P < 0.05, n = 103; hazard ratio = 1.095, 95% confidence interval = 1.031–1.163, for age, and hazard ratio = 3.075, 95% confidence interval = 1.244–7.600, for the GNRI). DeLong's test for the two correlated receiver operating characteristic curves [area under the receiver operating characteristic curve (AUROC) of serum albumin, 0.71; AUROC of the GNRI, 0.75] demonstrated significant differences between the groups ( P = 0.038). Adding the GNRI to the logBNP increased the AUROC for all‐cause death significantly (0.71 and 0.80, respectively; P = 0.040, n = 105). The addition of serum albumin or the body mass index to the logBNP did not significantly increase the AUROC for all‐cause death ( P = 0.082 and P = 0.29, respectively). Conclusions Nutritional screening using the GNRI at discharge is helpful to predict the long‐term prognosis of elderly HFpEF patients.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

et al. 2019

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“…[1][2][3] Also, the number of patients with heart failure (HF) is similarly increasing, and their high mortality and rates of readmission and increased medical expenses are becoming a problem. [4][5][6][7][8][9] In contrast, nutrition 10,11 in HF patients is a reported factor of mortality and readmission. In a report on the nutritional assessment of HF patients, the Geriatric Nutritional Risk Index (GNRI), which is measured using both serum albumin and body mass index (BMI), was shown to have excellent prognostic evaluation ability as compared with the measurement of serum albumin or BMI alone.…”

Section: Introductionmentioning

confidence: 99%

Differences in nutritional status and activities of daily living and mobility in elderly hospitalized patients with heart failure

Kitamura

Izawa

Yaekura³

et al. 2019

ESC Heart Failure

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Aims This study aims to examine the effect of differences in nutritional status on activities of daily living (ADL) and mobility recovery of hospitalized elderly patients with heart failure (HF). Methods and results From among 377 consecutive HF patients who underwent rehabilitation at one acute‐care hospital from January 2013 to August 2015, those who were aged ≥ 65 years could walk with assistance before hospitalization and who were hospitalized for the first time were included in this retrospective cohort study. Exclusion criteria were pacemaker surgery during hospitalization, change to other departments, death during hospitalization, and unmeasured ADL. We investigated patient characteristics, basic attributes, Geriatric Nutritional Risk Index (GNRI), ADL [motor Functional Independence Measure (motor FIM)], and Rivermead Mobility Index (RMI). Of these 377 patients, 96 met the inclusion criteria and were divided into the low GNRI group ( n = 38, 83.5 ± 8.3 years, 44.7% male) and high GNRI group ( n = 58, 81.0 ± 6.6 years, 55.2%). Patient characteristics and the difference between motor ADL and motility recovery and nutrition data were analysed with unpaired t ‐test, χ 2 test, and two‐way analysis of covariance. In comparing the two groups, the following parameters were significantly lower in the low GNRI group than in the high GNRI group: body mass index (18.7 ± 2.2 vs. 23.2 ± 2.7 kg/m 2 , P < 0.01), albumin (3.4 ± 0.4 vs. 3.8 ± 0.4 g/dL, P < 0.01), diabetes mellitus ratio (21.1% vs. 50.0%, P < 0.01), RMI at discharge (6.8 ± 2.6 vs. 8.2 ± 2.2, P = 0.01), and motor FIM at discharge (67.2 ± 19.5 vs. 75.6 ± 13.3, P = 0.02). RMI showed a significant group and term main effect and interaction effect ( P < 0.05). Motor FIM showed a significant main effect of group and term ( P < 0.05), and no significant interaction effect. Conclusions Low nutritional status in hospitalized elderly HF patients affected their recovery of mobility but did not appear to affect the recovery of ADL.

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“…Hypoalbuminaemia present in malnourished patients could be associated with changes in vascular permeability and/or decreased cardiac mass and function. In fact, several studies have shown that malnutrition is common in patients with acute/chronic heart failure; associates with worse cardiac outcomes, including higher risk of mortality; and could add valuable prognostic information …”

Section: Discussionmentioning

confidence: 99%

“…In fact, several studies have shown that malnutrition is common in patients with acute/chronic heart failure; associates with worse cardiac outcomes, including higher risk of mortality; and could add valuable prognostic information. 14,16,22,23 There are studies demonstrating that high CRP levels and hypoalbuminaemia both independently and synergistically increased the risk of MACE in the long term in patients undergoing percutaneous coronary intervention. 24 The present study is the first to assess their impact in an acute setting and basically demonstrated similar deleterious effects of the two biomarkers.…”

Section: Discussionmentioning

confidence: 99%

Altered nutritional status, inflammation and systemic vulnerability in patients with acute myocardial infarction undergoing percutaneous coronary revascularisation: A prospective study in a level 3 cardiac critical care unit

Rus

Chițu

Benedek

et al. 2019

Nutrition & Dietetics

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Aim The aim of the present study was to assess the influence of nutritional status, as expressed by Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) scores, on the inflammatory response following acute myocardial infarction (AMI) and the impact of an altered nutritional status and increased systemic inflammation on immediate evolution following AMI. Methods This was an observational prospective study in which we used the CONUT score and GNRI on 86 consecutive patients with AMI receiving primary revascularisation, divided into a well‐nourished group (CONUT score 0–2, n = 68) and moderate‐to‐severe nutritional deficit group (CONUT score ≥ 3, n = 18). Inflammatory status was assessed on the basis of highly sensitive C‐reactive protein (hs‐CRP) at baseline and on day 5. Results Malnourished patients presented significantly higher levels of serum hs‐CRP at baseline (33.6 ± 35.02 mg/dL vs 10.26 ± 25.93 mg/dL, P < 0.0001) and day 5 (52.8 ± 46.25 mg/dL vs 17.04 ± 24.78 mg/dL, P < 0.0001). GNRI values showed a weak but significant correlation with serum hs‐CRP at baseline (r = −0.26, P = 0.01) and day 5 (r = −0.44, P < 0.0001). Patients with altered nutritional status presented more frequent deterioration of their haemodynamical status, requiring inotropic support (P = 0.002) and longer hospitalisation in the acute cardiac care unit (4.27 ± 2.60 vs 2.85 ± 0.73 days, P = 0.005). Patients requiring intravenous inotropics had a higher CONUT score (2.31 ± 1.7 vs 1.17 ± 1.27, P = 0.01), lower GNRI (102.0 ± 5.31 vs 98.56 ± 5.2, P = 0.02) and higher hs‐CRP levels at baseline and day 5 (31.40 ± 46.57 vs 18.52 ± 32.98, P = 0.04 and 46.04 ± 51.50 vs 19.60 ± 46.05, P = 0.006). Conclusions Malnourished patients with AMI had more expressed inflammation, increased blood vulnerability and worse outcomes.

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Nutritional status is related to heart failure severity and hospital readmissions in acute heart failure

Cited by 76 publications

References 39 publications

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction

Differences in nutritional status and activities of daily living and mobility in elderly hospitalized patients with heart failure

Altered nutritional status, inflammation and systemic vulnerability in patients with acute myocardial infarction undergoing percutaneous coronary revascularisation: A prospective study in a level 3 cardiac critical care unit

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