Author + information
- Received January 4, 2018
- Revision received February 12, 2018
- Accepted February 22, 2018
- Published online May 28, 2018.
- Shirley Sze, MBBSa,∗ (, )
- Pierpaolo Pellicori, MDa,b,c,
- Syed Kazmi, MSca,
- Alan Rigby, MSca,
- John G.F. Cleland, MDb,c,
- Kenneth Wong, MDa,d and
- Andrew Lawrence Clark, MA, MDa
- aDepartment of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, United Kingdom
- bRobertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, Scotland, United Kingdom
- cNational Heart & Lung Institute, Imperial College, London, United Kingdom
- dLancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
- ↵∗Address for correspondence:
Dr. Shirley Sze, Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Castle Road, Cottingham, Kingston upon Hull HU16 5JQ, United Kingdom.
Objectives The authors sought to report the prevalence, clinical associations, and prognostic consequences of malnutrition in outpatients with heart failure (HF).
Background Malnutrition may be common in HF and associated with adverse outcomes, but few data exist.
Methods We applied the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI) to consecutive patients referred with suspected HF to a clinic serving a local population (n = 550,000).
Results Of 4,021 patients enrolled, HF was confirmed in 3,386 (61% men; median age: 75 years; interquartile range [IQR]: 67 to 81 years, median N-terminal pro–B-type natriuretic peptide [NT-proBNP]: 1,103 ng/l [IQR: 415 to 2,631 ng/l]). Left ventricular ejection fraction was <40% in 35% of patients. Using scores for GNRI ≤91, CONUT >4, and PNI ≤38, 6.7%, 10.0%, and 7.5% patients were moderately or severely malnourished, respectively; 57% were at least mildly malnourished by at least 1 score. Worse scores were most strongly related to older age, lower body mass index, worse symptoms and renal function, atrial fibrillation, anemia, and reduced mobility. During a median follow-up of 1,573 days (IQR: 702 to 2,799 days), 1,723 (51%) patients died. For patients who were moderately or severely malnourished, 1-year mortality was 28% for CONUT, 41% for GNRI, and 36% for PNI, compared with 9% for those with mild malnutrition or normal nutritional status. A model including only age, urea, and logNT-proBNP, predicted 1-year survival (C-statistic: 0.719) and was slightly improved by adding nutritional indices (up to 0.724; p < 0.001) but not body mass index.
Conclusions Malnutrition is common among outpatients with HF and is strongly related to increased mortality.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 4, 2018.
- Revision received February 12, 2018.
- Accepted February 22, 2018.
- 2018 American College of Cardiology Foundation