Protein-Energy Malnutrition and Outcomes of Hospitalizations for Heart Failure in the USA

• Published in: The American journal of cardiology Vol. 123; no. 6; pp. 929 - 935
• Main Authors: Adejumo, Adeyinka Charles, Adejumo, Kelechi Lauretta, Adegbala, Oluwole Muyiwa, Chinedozi, Ifeanyichukwu, Ndansi, Jordan, Akanbi, Olalekan, Onyeakusi, Nnaemeka Egbuna, Ogundipe, Olumuyiwa Akinbolaji, Bob-Manuel, Tamunoinemi, Adeboye, Adedayo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.03.2019; Elsevier Limited
• Subjects: Aged; Cardiovascular disease; Comorbidity; Congestive heart failure; Cytokines; Demographics; Diabetes; Diabetes mellitus; Energy; Female; Follow-Up Studies; Greedy algorithms; Health care policy; Health insurance; Heart; Heart failure; Heart Failure - epidemiology; Heart Failure - therapy; Hemodialysis; Hospital Costs; Hospital Mortality - trends; Hospitalization - statistics & numerical data; Humans; Hyperlipidemia; Inflammation; Length of Stay - trends; Male; Malnutrition; Mechanical ventilation; Medicaid; Mortality; Nutrition; Parenteral nutrition; Patients; Prognosis; Protein-energy malnutrition; Protein-Energy Malnutrition - epidemiology; Protein-Energy Malnutrition - therapy; Proteins; Renal failure; Respiratory failure; Retrospective Studies; Risk Assessment - methods; Risk Factors; Software; Survival Rate - trends; Time Factors; Ventilation; United States > US
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2018.12.014

Chronically elevated cytokines from un-abating low-grade inflammation in heart failure (HF) results in Protein-Energy Malnutrition (PEM). However, the impact of PEM on clinical outcomes of admissions for HF exacerbations has not been evaluated in a national data. From the 2012 to 2014 Nationwide Inpatient Sample (NIS) patient's discharge records for primary HF admissions, we identified patients with concomitant PEM, and their demographic and comorbid factors. We propensity-matched PEM cohorts (32,771) to no-PEM controls (1:1) using a greedy algorithm-based methodology and estimated the effect of different clinical outcomes (SAS 9.4). There were 32,771 (∼163,885) cases of PEM among the 541,679 (∼2,708,395) primary admissions for HF between 2012 and 2014 in the US. PEM cases were older (PEM:76 vs no-PEM:72 years), Whites (70.75% vs 67.30%), and had higher comorbid burden, with Deyo-comorbidity index >3 (31.61% vs 26.30%). However, PEM cases had lower rates of obesity, hyperlipidemia and diabetes. After propensity-matching, PEM was associated with higher mortality (AOR:2.48 [2.31 to 2.66]), cardiogenic shock (3.11[2.79 to 3.46]), cardiac arrest (2.30[1.96 to 2.70]), acute kidney failure (1.49[1.44 to 1.54]), acute respiratory failure (1.57[1.51 to 1.64]), mechanical ventilation (2.72[2.50 to 2.97]). PEM also resulted in higher non-routine discharges (2.24[2.17 to 2.31]), hospital cost ($80,534[78,496 to 82,625] vs $43,226[42,376 to 44,093]) and longer duration of admission (8.6[8.5 to 8.7] vs 5.3[5.2 to 5.3] days). In conclusion, PEM is a prevailing comorbidity among hospitalized HF subjects, and results in devastating health outcomes. Early identification and prevention of PEM in HF subjects during clinic visits and prompt treatment of PEM both in the clinic and during hospitalization are essential to decrease the excess burden of PEM.