Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Article

Hersberger, Lara^1,2  Dietz, Anna^1,2  Burgler, Helene^1,2  Bargetzi, Annika^1,2  Bargetzi, Laura^1,2  Kagi-Braun, Nina¹  Tribolet, Pascal³  Gomes, Filomena^1,4  Hoess, Claus⁵  Pavlicek, Vojtech⁵  Bilz, Stefan⁶  Sigrist, Sarah⁶  Brandle, Michael⁶  Henzen, Christoph⁷  Thomann, Robert⁸  Rutishauser, Jonas⁹  Aujesky, Drahomir¹⁰  Rodondi, Nicolas^10,11  Donze, Jacques^10,12  Stanga, Zeno¹³  Mueller, Beat^1,2  Schuetz, Philipp^1,2 

[1] Kantonsspital Aarau, Med Univ Dept, Div Gen Internal & Emergency Med, Aarau, Switzerland

[2] Univ Basel, Med Fac, Basel, Switzerland

[3] Spital Lachen, Internal Med, Oberdorf, Switzerland

[4] New York Acad Sci, New York, NY USA

[5] Kantonsspital Muensterlingen, Internal Med, Muensterlingen, Switzerland

[6] Kantonsspital St Gallen, Internal Med & Endocrinol Diabet, St Gallen, Switzerland

[7] Kantonsspital Luzern, Internal Med, Luzern, Switzerland

[8] Buergerspital Solothurn, Dept Internal Med, Solothurn, Switzerland

[9] Kantonsspital Baden, Internal Med, Baden, Switzerland

[10] Univ Bern, Bern Univ Hosp, Inselspital, Dept Gen Internal Med, Bern, Switzerland

[11] Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland

[12] Brigham & Womens Hosp, Div Gen Internal Med, 75 Francis St, Boston, MA 02115 USA

[13] Univ Bern, Bern Univ Hosp, Inselspital, Div Diabetol Endocrinol Nutr Med & Metab, Bern, Switzerland

关键词: KEY WORDS cardiology;    cardiovascular;    clinical outcomes;    heart failure;    malnutrition;    Nutritional Risk Screening;    nutritional support;   

DOI  :  10.1016/j.jacc.2021.03.232

来源: Elsevier

【 摘 要 】

BACKGROUND Deterioration of nutritional status during hospitalization in patients with chronic heart failure increases mortality. Whether nutritional support during hospitalization reduces these risks, or on the contrary, may be harmful due to an increase in salt and fluid intake, remains unclear. OBJECTIVES The purpose of this trial was to study the effect of nutritional support on mortality in patients hospitalized with chronic heart failure who are at nutritional risk. METHODS A total of 645 patients with chronic heart failure (36% [n = 234] with acute decompensation) participated in the investigator-initiated, open-label EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients) trial. Patients were randomized to protocol-guided individualized nutritional support to reach energy, protein, and micronutrient goals (intervention group) or standard hospital food (control group). The primary endpoint was all-cause mortality at 30 days. RESULTS Mortality over 180 days increased with higher severity of malnutrition (odds ratio per 1-point increase in Nutritional Risk Screening 2002 score: 1.65; 95% confidence interval [CI]: 1.21 to 2.24; p = 0.001). By 30 days, 27 of 321 intervention group patients (8.4%) died, compared with 48 of 324 (14.8%) control group patients (odds ratio: 0.44; 95% CI: 0.26 to 0.75; p = 0.002). Patients at high nutritional risk showed the most benefit from nutritional support. Mortality effects remained significant at 180-day follow-up. Intervention group patients also had a lower risk for major cardiovascular events at 30 days (17.4% vs. 26.9%; odds ratio: 0.50; 95% CI: 0.34 to 0.75; p = 0.001). CONCLUSIONS Among hospitalized patients with chronic heart failure at high nutritional risk, individualized nutritional support reduced the risk for mortality and major cardiovascular events compared with standard hospital food. These data support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this vulnerable patient population. (Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial [EFFORT]; NCT02517476) (J Am Coll Cardiol 2021;77:2307-19) (c) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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