Potential association with malnutrition and allocation of combination medical therapies in hospitalized heart failure patients with reduced ejection fraction

Abstract

Malnutrition is common in patients with heart failure with reduced ejection fraction (HFrEF) and may influence the long-term prognosis and allocation of combination medical therapy. We reviewed 1231 consecutive patient-level records from a multicenter Japanese registry of hospitalized HFrEF patients. Nutritional status was assessed using geriatric nutritional risk index (GNRI). Combination medical therapy were categorized based on the use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists. The composite outcome of all-cause death and HF rehospitalization was assessed. The mean age was 72.0 ± 14.2 years and 42.6% patients were malnourished (GNRI < 92). At discharge, 43.6% and 33.4% of patients were receiving two and three agents, respectively. Malnourished patients had lower rates of combination medical therapy use. The standardized GNRI score was independently associated with the occurrence of adverse events (hazard ratio [HR]: 0.88, 95% confidence interval [CI] 0.79–0.98). Regardless of the GNRI score, referenced to patients receiving single agent, risk of adverse events were lower with those receiving three (HR: 0.70, 95% CI 0.55–0.91) or two agents (HR: 0.70, 95% CI 0.56–0.89). Malnutrition assessed by GNRI score predicts long-term adverse outcomes among hospitalized HFrEF patients. However, its prognosis may be modified with combination medical therapy.

Impact of malnutrition on mortality and neurological recovery of older patients with spinal cord injury

“…We used GNRI in this study, rather than a single BMI or serum albumin (Alb) level, to assess the nutritional status 15 , 16 . Although GNRI has not previously been reported for SCI, the index was used in nutrition and other areas, such as urology, geriatrics, and cardiology 17 – 19 . For example, Kobayashi et al showed that the GNRI is a substantial predictor for mortality among patients undergoing hemodialysis 17 , while Ruan et al reported that the GNRI can serve as an independent prognostic factor for the overall survival of older patients with cancer cachexia 18 .…”

“…For example, Kobayashi et al showed that the GNRI is a substantial predictor for mortality among patients undergoing hemodialysis 17 , while Ruan et al reported that the GNRI can serve as an independent prognostic factor for the overall survival of older patients with cancer cachexia 18 . Additionally, Kawakubo et al revealed that malnutrition assessed using the GNRI predicts long-term adverse outcomes among hospitalized patients with heart failure with reduced ejection fraction 19 . Following these studies, we revealed that the GNRI would be useful in evaluating older patients with traumatic SCI.…”

“…The Geriatric Nutrition Risk Index (GNRI) is a simple index of nutrition-related risk that focuses on the evaluation of older patients 15 . This index has recently been shown to be an objective and reliable tool for assessing nutrition-related risk in various pathological conditions in the older population 16 – 19 . Therefore, this study aimed to determine nutrition-related risk and its impact on mortality and neurological recovery of older patients with cervical SCI using GNRI.…”