Prognostic Value of In-Hospital Nutritional Status Improvement in Heart Failure: Insights From JROADHF-NEXT Registry

TL;DR

Improving nutritional status during hospitalization for heart failure is linked to better survival and fewer readmissions.

Contribution

This study shows that in-hospital improvement in nutritional status predicts better outcomes in heart failure patients.

Findings

Patients with improved CONUT scores had significantly lower mortality rates after discharge.

Improvement in nutritional status was associated with reduced risk of heart failure rehospitalization.

Propensity score matching confirmed the benefit of nutritional improvement on survival.

Abstract

Malnutrition is common in heart failure (HF) and is associated with poor outcomes; however, longitudinal changes in the nutritional status of patients with HF are poorly investigated.

To assess the prognostic impact of changes in Controlling Nutritional Status (CONUT) score and identify predictors of malnutrition improvement in hospitalized patients with HF.

We analyzed data on 4,016 patients from a nationwide acute HF registry in Japan (UMIN ID: UMIN000036592). We identified 812 patients with moderate or severe malnutrition at admission (CONUT score ≥5) and stratified them into an improvement (IMP, n = 168) or non-improvement (Non-IMP, n = 644) group based on in-hospital change in CONUT score. The primary outcome was all-cause mortality; the secondary outcome was a composite endpoint of all-cause mortality and HF rehospitalization.

Over a median follow-up of 712 days (IQR, 392–768 days), all-cause mortality was significantly lower in the IMP group than in the Non-IMP group (11.90% vs. 30.12%; log-rank P < 0.0001). The composite endpoint was also lower in the IMP group (29.76% vs. 47.98%; log-rank P < 0.0001). After propensity score matching, the IMP group had consistently lower all-cause mortality and composite endpoints than the Non-IMP group (log-rank P = 0.0002; log-rank P = 0.041). Multivariable Cox proportional hazards model for all-cause mortality with overlap weighting demonstrated that CONUT improvement was associated with lower all-cause mortality (HR, 0.357; 95% CI, 0.205–0.624; P = 0.0003).

In hospitalized patients with acute HF and moderate to severe malnutrition, improvement in CONUT score during hospitalization was associated with lower post-discharge mortality and rehospitalization.

Figures