Review of nutritional screening and assessment tools and clinical outcomes in heart failure

Abstract

Recent studies have suggested that undernutrition as defined using multidimensional nutritional evaluation tools may affect clinical outcomes in heart failure (HF). The evidence supporting this correlation is unclear. Therefore, we conducted this systematic review to critically appraise the use of multidimensional evaluation tools in the prediction of clinical outcomes in HF. We performed descriptive analyses of all identified articles involving qualitative analyses. We used STATA to conduct meta-analyses when at least three studies that tested the same type of nutritional assessment or screening tools and used the same outcome were identified. Sensitivity analyses were conducted to validate our positive results. We identified 17 articles with qualitative analyses and 11 with quantitative analysis after comprehensive literature searching and screening. We determined that the prevalence of malnutrition is high in HF (range 16-90 %), particularly in advanced and acute decompensated HF (approximate range 75-90 %). Undernutrition as identified by multidimensional evaluation tools may be significantly associated with hospitalization, length of stay and complications and is particularly strongly associated with high mortality. The meta-analysis revealed that compared with other tools, Mini Nutritional Assessment (MNA) scores were the strongest predictors of mortality in HF [HR (4.32, 95 % CI 2.30-8.11)]. Our results remained reliable after conducting sensitivity analyses. The prevalence of malnutrition is high in HF, particularly in advanced and acute decompensated HF. Moreover, undernutrition as identified by multidimensional evaluation tools is significantly associated with unfavourable prognoses and high mortality in HF.

Utility of Nutritional Screening in Predicting Short-Term Prognosis of Heart Failure Patients

“…Narumi, et al 14) noted a malnutrition prevalence of 60-69% in chronic HF patients. Additionally, according to a recent review by Lin, et al 6) , the prevalence of malnutrition is higher in advanced HF, and in acute decompensated HF (75-90%). The undernutrition prevalence in our study population is comparable to those reported in the above-mentioned studies.…”

“…The undernutrition prevalence in our study population is comparable to those reported in the above-mentioned studies. 6,9,14) Therefore, supportive therapies should be promptly administered on the assumption that hospitalized HF patients often have undernutrition. Furthermore, as HF and undernutrition can each influence the other, once patients develop severe HF, their nutritional status deteriorates further.…”

“…In a recently published review by Lin, et al 6) , the use of various nutritional assessment and screening tools was compared in studies conducted on HF patients. The study compared the usage frequency of 2 nutritional assessment tools [Mini Nutritional Assessment (MNA), and SCORE], 7 nutritional screening tools [MNA-short-form (SF), Nutritional Risk Screening, Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index, CONUT, and the Nutritional Screening Initiative], and 2 other tools.…”

“…Intestinal edema or anorexia-induced low nutritional intake, liver dysfunction, cytokine-induced hypercatabolism, insulin resistance, and other mechanisms may all result in HFrelated undernutrition. 6) HF patients with undernutrition…”

Nutrient Deficiencies in Heart Failure: A Micro Problem With Macro Effects?

“…Depending on illness severity and the screening method, 15% to 90% of patients hospitalized for HF are undernourished. Malnutrition markedly increases the risk for hospital readmission and death 11. Yet, little is known about how dietary intake changes over the course of HF or how such changes may affect outcomes.…”