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. 2023 Nov;71(11):3367-3375.
doi: 10.1111/jgs.18590. Epub 2023 Sep 14.

Malnutrition in heart failure with preserved ejection fraction

Omar Zainul  1 , Danny Perry  2 , Michael Pan  3 , Jennifer Lau  4 , Kate Zarzuela  4 , Ryan Kim  1 , Matthew C Konerman  2 , Scott L Hummel  2   5 , Parag Goyal  4
Affiliations

Malnutrition in heart failure with preserved ejection fraction

Omar Zainul et al. J Am Geriatr Soc. 2023 Nov.

Abstract

Background: Malnutrition may be an important geriatric condition in adults with heart failure with preserved ejection fraction (HFpEF), but studies on its prevalence and associated clinical outcomes are limited. The aim of this study was to determine if malnutrition is associated with short-term morbidity and mortality in ambulatory patients with HFpEF.

Methods: We examined 231 patients with a clinical diagnosis of HFpEF seen at two dedicated academic HFpEF programs (Weill Cornell Medicine and Michigan Medicine) from June 2018 to April 2022. Malnutrition was defined by Mini-Nutritional Assessment Short Form (MNA-SF) scores ≤11. The primary endpoint was a 6-month composite of all-cause mortality and all-cause hospitalization. A Cox proportional-hazard models was used to examine the association between malnutrition and the primary endpoint, adjusting for race, prior hospitalization history, and the validated Meta-Analysis Global Group in Chronic (MAGGIC) heart failure prognostic risk score.

Results: The median age of the cohort was 73 years (interquartile range 64-81). The most common comorbid conditions included hypertension (prevalence 81%), atrial fibrillation (43%), and obesity (63%). The prevalence of malnutrition was 42% (n = 97), and MNA-SF scores did not significantly correlate with body mass index (R = -0.02, p = 0.71). At the 6-month follow-up, 62 patients (26.8%) were hospitalized and four patients died (1.7%). In a fully-adjusted analysis, malnutrition was independently associated with the composite outcome of all-cause mortality and all-cause hospitalization (HR 1.94 [95% CI: 1.17-3.20], p = 0.01).

Conclusion: Despite a high prevalence of obesity, two out of five ambulatory adults with HFpEF are malnourished. Malnutrition was independently associated with adverse outcomes at 6 months. Future work is necessary to develop interventions that can address malnutrition.

Keywords: body mass index; heart failure with preserved ejection fraction; hospitalization; malnutrition; mortality; prognosis.

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Conflict of interest statement

Conflicts of Interest:

None.

Figures

Figure 1:
Figure 1:
Comparison of MNA-SF Scores and BMI. Abbreviations: BMI: Body mass index; MNA-SF: Mini nutritional assessment short form
Figure 2:
Figure 2:
Kaplan-Meier curve for the composite outcome of all-cause mortality or hospitalization for patients with (MNA-SF ≤11) and without (MNA-SF > 11) malnutrition. Abbreviations: MNA-SF: Mini nutritional assessment short form
See this image and copyright information in PMC

Comment in

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