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. 2021 Jun;8(3):1819-1826.
doi: 10.1002/ehf2.13279. Epub 2021 Mar 2.

Differential effect of malnutrition between patients hospitalized with new-onset heart failure and worsening of chronic heart failure

Koichiro Matsumura  1   2 , Wakana Teranaka  1 , Masanao Taniichi  1 , Munemitsu Otagaki  1 , Hiroki Takahashi  1 , Kenichi Fujii  1 , Yoshihiro Yamamoto  1 , Gaku Nakazawa  2 , Ichiro Shiojima  1
Affiliations

Differential effect of malnutrition between patients hospitalized with new-onset heart failure and worsening of chronic heart failure

Koichiro Matsumura et al. ESC Heart Fail. 2021 Jun.

Abstract

Aims: We aimed to investigate the differences in the prevalence, severity, and prognostic impact of malnutrition between patients with new-onset heart failure (HF) and worsening of chronic HF.

Methods and results: In older (≥60 years) hospitalized patients with acute HF, malnutrition was assessed according to the Geriatric Nutritional Risk Index (GNRI). A score <92 was defined as malnutrition. The primary endpoint was a composite endpoint, including cardiac death or rehospitalization for HF. Among 210 patients, 37% (52/142) of patients with new-onset HF and 31% (21/68) of patients with worsening of chronic HF had malnutrition (P = 0.41). The GNRI classification was comparable between the two groups. Kaplan-Meier analysis revealed a significant difference in the incidence of the composite endpoint in patients with new-onset HF (GNRI < 92 vs. GNRI ≥ 92: 50% vs. 32%, P = 0.007), but not in patients with worsening of chronic HF (GNRI < 92 vs. GNRI ≥ 92: 67% vs. 68%, P = 0.91). The adjusted Cox proportional hazards model demonstrated that a GNRI of <92 was an independent prognostic factor for the composite endpoint in patients with new-onset HF only.

Conclusions: Among older hospitalized patients with acute HF, the prevalence and severity of malnutrition were comparable between the two categories of patients. Malnutrition was an independent prognostic factor in patients with new-onset HF, while clinical prognosis was poor in patients with worsening of HF, irrespective of malnutrition. The prognostic impact of malnutrition differs between new-onset HF and worsening of chronic HF.

Keywords: Acute heart failure; Geriatric Nutritional Risk Index; New-onset heart failure; Worsening of chronic heart failure.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Nutritional status between new‐onset heart failure (HF) and worsening of chronic HF according to Geriatric Nutritional Risk Index (GNRI). (A) Comparison of GNRI; no significant difference was observed between the two groups. (B) Distribution of GNRI classification. Patients with GNRI scores of ≥98, ≥92 to <98, ≥82 to <92, and <82 correspond to normal, low risk, moderate risk, and severe risk of malnutrition, respectively. No significant differences were observed between the two groups. The blue bar indicates patients with new‐onset HF, and the red bar indicates patients with worsening of chronic HF.
Figure 2
Figure 2
Kaplan–Meier analysis of patients who did not reach a composite endpoint, including those with cardiac death or rehospitalization for heart failure (HF). (A) Patients with new‐onset HF; (B) patients with worsening of chronic HF. The red line indicates patients with Geriatric Nutritional Risk Index (GNRI) ≥92, and the blue line indicates patients with GNRI < 92.
Figure 3
Figure 3
Kaplan–Meier analysis of patients who experienced cardiac death and rehospitalization for heart failure (HF). (A, C) Patients with new‐onset HF; (B, D) patients with worsening of chronic HF. The red line indicates patients with Geriatric Nutritional Risk Index (GNRI) ≥92, and the blue line indicates patients with GNRI < 92.
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