Nutritional support can save lives in heart failure


Personalized nutritional support for hospitalized adults with chronic diseases heart attack and is thought to have a high nutritional risk, reduced the risk of dying or suffering from adverse cardiovascular events compared to standard hospital foods, according to new research.

The Swiss EFFORT trial focused on patients with chronic heart failure and high risk of malnutrition defined by a low body mass index (BMI), weight loss, and low food intake on admission to the hospital.

“This high-risk group of patients with chronic heart failure showed a significant improvement in mortality over 30 and 180 days, as well as other clinical outcomes, when individualized nutritional support interventions were offered to patients,” Philipp Schuetz, MD , MPH, Kantara Hospital Aarau, Said Aarau, Switzerland | Cardiology Medscape.

“Although nutritional status control should also be done in outpatients before [general practitioners], screening for malnutrition on admission to hospital can help identify high-risk patients with a high risk of deteriorating nutritional status during their hospital stay who will benefit from nutritional assessment and treatment, ”he said. dir Schuetz.

The study was published online May 3 at Journal of the American College of Cardiology.

Not everything is salt

The results are based on a predetermined secondary analysis of outcomes in 645 patients (mean age, 78.8 years, 52% men) hospitalized with chronic heart failure who participated in the open-label EFFORT study.

One-third of patients were hospitalized for decompensated acute heart failure and two-thirds had chronic heart failure and other acute medical conditions that required hospitalization.

All patients had a risk of malnutrition based on a nutritional risk screening score (NRS) of 3 points or more. They were randomly assigned 1: 1 to individualized nutritional support to achieve energy, protein, and micronutrient goals or regular hospital food (control group).

At 30 days, 27 of 321 patients (8.4%) receiving nutritional support had died compared with 48 of 324 patients (14.8%) in the control group (adjusted probability) [OR]: 0.44; 95% CI: 0.26-0.75; Pg = .002)

Patients with a high nutritional risk (NRS> 4 points) showed the maximum benefit of nutritional support.

Compared with patients with moderate nutritional risk scores (NRS score of 3 to 4), those with a high nutritional risk (NRS> 4) had a significant 65% increase in mortality risk for 180 days.

The individual component of SNR with a stronger association with mortality was low food intake the week prior to hospitalization.

Patients who received nutritional support at the hospital also had a lower risk of major cardiovascular events at 30 days (17.4% vs. 26.9%; OR, 0.50; 95% CI: 0.34 – 0.75; P = .001).

“Historically, cardiologists and internists caring for patients with heart failure have focused primarily on restrictive salt diets to reduce blood volume and optimize heart function. However, it has not been shown that reducing intake of salt effectively improves the clinical outcome, but on the contrary, increases the risk of malnutrition, as low-salt diets are often not tasty, “said Schuetz. | Cardiology Medscape.

“Our data suggest that we should move our focus away from salt-restrictive diets to protein-rich diets to cover individual nutritional goals in this group of high-risk patients that includes screening, assessment, and nutritional support for dietitians.” said Schuetz.

In a linked publisher, Sheldon Gottlieb, MD, Johns Hopkins School of Medicine, Baltimore, Maryland, says “relatively little attention” has been paid to the role of diet in heart failure, other than recommending a reduced salt intake.

In fact, in the 2021 expert recommendations of the American College of Cardiology to optimize treatment for heart failure, approximately five words are devoted to diet and exercise and no mention is made of the nutritional assessment of a dietitian, he points out.

“This study adds another mosaic to the still fragmentary mosaic image of the nutritionally at-risk heart failure patient who could benefit from nutritional support,” Gottlieb writes.

“Good medical care” determines that all hospitalized patients deserve to have a standardized nutritional assessment; the challenge remains: how to determine which patient with heart failure at nutritional risk will benefit from medical nutrition therapy, ”says Gottlieb.

The Swiss National Science Foundation and the Research Council of the Kantonsspital Aarau provided funding for the test. Schuetz’s institution had previously received unrestricted grant money outside of this Nestle Health Science and Abbott Nutrition project. Gottlieb has a federal trademark for the “Greens, Beans, and Leans” diet and has a pending federal trademark for “FLOATS”: flax + oat cereals.

J Am Coll Cardiol. Published online May 3, 2021. Summary, Editorial

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