Prognostic impact of nutritional status and physical capacity in elderly patients with acute decompensated heart failure

• Published in: ESC Heart Failure Vol. 7; no. 4; pp. 1801 - 1808
• Main Authors: Yasumura, Kaori, Abe, Haruhiko, Iida, Yoshinori, Kato, Taishi, Nakamura, Masayuki, Toriyama, Chieko, Nishida, Hiroki, Idemoto, Akiko, Shinouchi, Kazuya, Mishima, Tsuyoshi, Awata, Masaki, Date, Motoo, Ueda, Yasunori, Uematsu, Masaaki, Koretsune, Yukihiro
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2020; John Wiley and Sons Inc; Wiley
• Subjects: Acute decompensated heart failure; Age; Body mass index; Cardiomyopathy; Cardiovascular disease; Chronic obstructive pulmonary disease; Elderly patients; Geriatric nutritional risk index; Heart failure; Hemoglobin; Hospitals; Laboratories; Malnutrition; Medical records; Mortality; Nutritional status; Original; Original s; Patients; Proteins; Rehabilitation; Sarcopenia; Simple walking test; Variables; Vital signs; Walking; Acute decompensated heart failure; Geriatric nutritional risk index; Elderly patients; Simple walking test
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.12743

Aims Nutritional status as well as physical capacity is related to prognosis in patients with heart failure. The purpose of this study was to explore a simple prognostic indicator in patients with acute decompensated heart failure (ADHF) by including both nutritional status and physical capacity. Methods and results Patients hospitalized with ADHF (N = 203; mean age, 81 years) were enrolled. We evaluated the geriatric nutritional risk index (GNRI) on hospital admission and at discharge. A GNRI score < 92 was defined as malnutrition. Physical capacity was evaluated by simple walking test to determine if patients could walk 200 m, with a Borg scale score ≤ 13, without critical changes in vital signs. Primary endpoints were mortality and heart failure rehospitalization within 2 years. A total of 49% and 48% of patients showed malnutrition on admission and at discharge, respectively. Malnutrition at discharge was more strongly related to mortality [hazard ratio (HR) 3.382, 95% confidence interval (CI) 1.900–6.020, P < 0.0001)] than that on admission (HR 2.448, 95% CI 1.442–4.157, P = 0.001) by univariable analysis. Malnutrition at discharge was related to mortality (HR 2.370, 95% CI 1.166–4.814, P = 0.02), but malnutrition on admission was not related (HR 1.538, 95% CI 0.823–2.875, P = 0.18) by multivariable analysis. Almost half of patients (45%) could not walk 200 m, which was significantly related to mortality by univariable analysis (HR 3.303, 95% CI 1.905–5.727, P < 0.0001), but was not by multivariable analysis (HR 1.990, 95% CI 0.999–3.962, P = 0.05). The combined index including both GNRI and simple walking test was an independent and stronger predictor of mortality than either index alone by multivariable analysis (HR 2.249, 95% CI 1.362–3.716, P < 0.01). Neither malnutrition nor low physical capacity was related to heart failure rehospitalization by univariable analysis (HR 0.702, 95% CI 0.483–1.020, P = 0.06; HR 1.047, 95% CI 0.724–1.515, P = 0.81, respectively). Malnutrition at discharge significantly reduced heart failure rehospitalization by multivariable analysis (HR 0.431, 95% CI 0.266–0.698, P < 0.01). When patients were classified into Group G (both nutritional status and physical capacity at discharge were good), Group E (either was good), and Group B (both were bad), mortality rates were significantly different among the groups (log rank P < 0.0001). Conclusion A simple indicator including both nutritional status and physical capacity may predict 2 year mortality in elderly patients with ADHF.