Malnutrition in hospital admissions for heart failure in switzerland- epidemiology and clinical outcomes, 1998–2022

Background

Malnutrition is frequent but under-recognized condition among heart failure (HF) patients. Its temporal trends and association with in-hospital outcomes on population level remain limited.

Methods

We performed a nationwide retrospective analysis of hospitalizations for HF hospitalizations using the Swiss hospital discharge data from 1998 to 2022. Malnutrition was defined in two ways; as ICD-10[1] codes E40 to E46 (M1), and ICD-10 codes plus the receipt of enteral (CHOP[2] code beginning with 96.6) or parenteral (code 99.15) nutrition among hospitalizations without a malnutrition code (M2). Bivariate and multivariable analyses was used to find associations of clinical outcomes (Intensive Care Unit (ICU) admission, prolonged (>5 days) Length of Stay (LoS) and in-hospital mortality) with malnutrition and nutritional interventions (dietetic consultation (DC) and, (par)enteral nutrition support (PN and EN)).

Results

Among 332,870 hospitalizations for HF (48.3% female), malnutrition according to definition M1 was identified in 6.76%. The prevalence increased significantly from 0.1% in 1998 to 15.0% in 2022 (p for trend <0.001). After multivariable adjustment, malnutrition was found associated with higher odds of ICU admission (OR, 95% CI 1.27, 1.21–1.34), prolonged LoS (5.00, 4.75–5.27), and in-hospital mortality (1.21, 1.15–1.27). Using definition M2, malnutrition was associated with increased odds of ICU admission (1.93, 1.84–2.01), prolonged length of stay (4.78, 4.55–5.01), and in-hospital mortality (1.41, 1.35–1.47).

A rising temporal trend was observed for the percentage of HF patients receiving dietetic consultation, from 0.0% in 1998 to 11.9% in 2022. Overall, dietetic consultation was provided to 5.6% of the HF patients. Dietetic consultation and nutrition support were associated with a higher likelihood of ICU admission (DC:1.22, 1.15-1.29; EN: 14.82, 13.28-16.54; PN: 7.70, 6.32-9.37), in hospital mortality (DC:1.04, 0.15-1.10NS; EN: 3.65, 3.26-4.10; PN: 3.58, 2.95-4.35) and prolonged LoS (DC: 7.07, 6.62-7.57; EN: 2.34, 1.96-2.77; PN: 2.38, 1.77-3.20), likely due to the already severe disease in patients requiring nutrition support. Similar findings for in hospital mortality and prolonged LoS were replicated when ICU admissions were excluded from the analysis.

Conclusion

Hospital malnutrition among HF patients appears increasingly prevalent yet underestimated. Malnutrition is associated with more severe conditions and adverse clinical outcomes. Rising trend of dietetic consultations in past years is encouraging but overall coverage still calls for further action and systematic screening, diagnosis and documentation practices for hospital malnutrition.