Nutritional Vulnerability and Functional Decline in End-Stage Heart Failure and Chronic Respiratory Disease: Utility of the CONUT Score in a Palliative Cohort

TL;DR

This study finds that patients with end-stage heart failure have higher malnutrition rates than those with chronic respiratory disease, and the CONUT score helps identify nutritional vulnerability in palliative care.

Contribution

The study compares malnutrition in heart failure and respiratory disease patients and evaluates the CONUT score's utility in palliative care.

Findings

CHF patients had significantly higher rates of moderate-to-severe malnutrition compared to CRD patients.

The CONUT score correlated more strongly with functional impairment than disease type alone.

Nutritional interventions in CHF patients did not improve their nutritional classification.

Abstract

Background/Objectives: Malnutrition is common among patients with advanced chronic illnesses receiving palliative care, yet comparative data between diagnostic groups are limited. This study aimed to evaluate and compare the nutritional status of patients with end-stage chronic heart failure (CHF) and chronic respiratory disease (CRD), and to assess the clinical utility of the Controlling Nutritional Status (CONUT) score in this setting. Methods: We conducted a retrospective analysis of 80 patients (41 with CHF, 39 with CRD) enrolled in a palliative care program (mean age 77.8 ± 6.8 years, 65% male). Nutritional status was assessed using BMI (Body Mass Index), CONUT score, and routine biochemical markers. Functional and clinical variables, including the Palliative Performance Scale (PPS), were also collected. Results: Moderate-to-severe malnutrition (CONUT ≥ 5) was significantly more prevalent in patients with CHF patients (44%) than CRD patients (10%, p = 0.002). CHF patients exhibited lower BMI, cholesterol, lymphocyte counts, and prealbumin levels. Despite more frequent nutritional follow-up and protein supplementation in the CHF group, these interventions were not associated with improved nutritional classification. The CONUT score correlated more strongly with functional impairment (PPS) than with disease type alone. Conclusions: Patients with CHF receiving palliative care demonstrate higher rates of malnutrition than those with CRD. The CONUT score, derived from standard blood test, may be pragmatic screening tool for identifying nutritional vulnerability and guiding interventions. While it does not predict survival, it may help detect functional decline earlier and support care strategies aimed at maintaining quality of life in end-stage disease.

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