The malnourished heart failure patient: the impact by ejection fraction

Introduction

Patients with heart failure (HF) are advised on fluid intake, salt intake and weight management. However, rarely is a full nutritional assessment completed. Screening tools such as the Prognostic Nutritional Index (PNI) may be used for initial screening, with low PNI associated with a poorer prognosis. It has been suggested that nutritional status is an independent modifiable prognostic factor within HF. However, there is limited evidence with regards to each HF phenotype – reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) respectively.

Aim

To evaluate the relationship between PNI, mortality and HF hospitalisation (HFH) within each HF phenotype.

Methods

This was a single-centre retrospective study of patients admitted with HF (September 2022-2023). PNI on admission was calculated by [albumin(g/L) + (0.005xlymphocytes/mm3)] whereby normal PNI≥50, mild malnutrition<50, moderate<45 and severe<40. Electronic health records were reviewed for mortality and HFH outcomes.

Results

194 patients were included. No patient had a PNI≥50.

Within the HFrEF group (n=98), 5% had a PNI 45-49, 34% had a PNI 40-44, and 61% had a PNI<40. Average BMI 30.

20% of PNI 45-49 group had a mortality at 1 year post discharge, compared to 24% in the PNI 40-44 group and 50% in the PNI<40 group. The HFH at 1 year was largely similar at 20% in PNI 45-49 group, 27% in PNI 40-44 group and 17% in the PNI<40 group.

Within the HFmrEF group (n=31), 10% had a PNI 45-49, 19% had a PNI 40-44, and 71% had a PNI<40. Average BMI 29.

The 1-Year Mortality was 67% in PNI 45-49 group, 50% in the PNI 40-44 group and 41% in the PNI<40 group. The HFH at 1 year was 33% in PNI 45-49 group, 0% in PNI 40-44 group and 23% in the PNI<40 group.

Within the HFpEF group (n=65), 0% had a PNI 45-49, 37% had a PNI 40-44, and 63% had a PNI<40. Average BMI 31.

The 1-Year Mortality was 0% in PNI 45-49 group, 21% in the PNI 40-44 group and 34% in the PNI<40 group. The HFH at 1 year was 0% in PNI 45-49 group, 33% in PNI 40-44 group and 32% in the PNI<40 group.

Conclusion

Within each cohort, all patients had a degree of malnutrition, with the majority severely malnourished, despite an elevated BMI. Within the HFrEF and HFpEF groups, there was considerable mortality and morbidity associated with higher degrees of malnutrition. As such, nutritional status should be considered an important variable to be screened for and addressed.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.