Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure.

Hersberger, Lara; Dietz, Anna; Bürgler, Helene; Bargetzi, Annika; Bargetzi, Laura; Kägi-Braun, Nina; Tribolet, Pascal; Gomes, Filomena; Hoess, Claus; Pavlicek, Vojtech; Bilz, Stefan; Sigrist, Sarah; Brändle, Michael; Henzen, Christoph; Thomann, Robert; Rutishauser, Jonas; Aujesky, Drahomir; Rodondi, Nicolas; Donzé, Jacques; Stanga, Zeno; ... (2021). Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure. Journal of the American College of Cardiology, 77(18), pp. 2307-2319. Elsevier 10.1016/j.jacc.2021.03.232

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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).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Aujesky, Drahomir; Rodondi, Nicolas; Donzé, Jacques and Stanga, Zeno

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0735-1097

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

14 May 2021 17:55

Last Modified:

14 May 2021 20:06

Publisher DOI:

10.1016/j.jacc.2021.03.232

PubMed ID:

33958128

Uncontrolled Keywords:

Nutritional Risk Screening cardiology cardiovascular clinical outcomes heart failure malnutrition nutritional support

BORIS DOI:

10.48350/156332

URI:

https://boris.unibe.ch/id/eprint/156332

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