Individualized nutrition support lowered mortality after heart failure hospitalization

The greatest benefit from an inpatient nutritional intervention was seen in men older than 78 years who had other acute and chronic medical illnesses in addition to heart failure, according to this secondary analysis of a randomized trial in Switzerland.

Heart failure patients who got individualized nutritional support during hospitalization had lower rates of mortality after discharge, a recent study found.

This secondary analysis of the open-label Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial (EFFORT) included 645 heart failure patients in Switzerland (36% admitted with acute decompensation, the rest for other diagnoses). All EFFORT participants had at least three points on the Nutritional Risk Screening (NRS) 2002 and an expected length of stay greater than four days. During hospitalization, they were randomized to either standard hospital food or protocol-guided individualized nutritional support to reach energy, protein, and micronutrient goals. Results were published by JACC on May 3.

Patients with higher severity of malnutrition according to the NRS 2002 had higher mortality risk during 180 days of follow-up (odds ratio per 1-point increase, 1.65; 95% CI, 1.21 to 2.24; P=0.001). The mortality rate was significantly lower at 30 days in patients who got individualized nutrition support (8.4% vs. 14.8%; odds ratio [OR], 0.44 [95% CI, 0.26 to 0.75]; P=0.002) and remained so at 180 days. Intervention group patients also had a lower rate of major cardiovascular events at 30 days (17.4% vs. 26.9%; OR, 0.50 [95% CI, 0.34 to 0.75]; P=0.001). The study also found that patients at high nutritional risk showed the most benefit from nutritional support.

The authors concluded that the results “support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this vulnerable patient population.” They noted that the trial doesn't “provide evidence for effects of single nutritional components, but rather suggests that the overall strategy of providing nutritional support to reach different nutritional goals during a hospital stay for an acute illness is beneficial for patients with chronic heart failure.” They called for validation of their findings and research into nutritional support for outpatients with heart failure.

An accompanying editorial highlighted the fact that the effects of the intervention differed by patient subgroup, noting that “the patients who appeared to benefit most were men older than 78 years with systolic heart failure and other acute and chronic medical illnesses.” All hospitalized patients should receive nutritional assessment, the editorialist wrote, adding that the real challenge is how to determine which patients with heart failure and nutritional risk benefit from medical nutrition therapy.