Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure - Hersberger, L.; Dietz, A.; Burgler, H.; Bargetzi, A.; Bargetzi, L.; Kagi-Braun, N.; Tribolet, P.; Gomes, F.; Hoess, C.; Pavlicek, V.; Bilz, S.; Sigrist, S.; et al. (J Am Coll Cardiol, 2021)
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).
Keywords: journalArticle; (1410.000.058 and 1410.000.044) provided funding for the trial. The funders had; (SNSF) (PP00P3_150531) and the Research Council of the Kantonsspital Aarau; *Hospitalization; *Nutritional Support; Aged; Aged, 80 and over; Chronic Disease; Female; Fresenius Kabi. Dr. Schuetz's institution has previously received unrestricted; Heart Failure/*mortality/therapy; Humans; Male; Middle Aged; Nutrition. All other authors have reported that they have no relationships; Nutritional Risk Screening; and the decision to submit. Dr. Stanga's institution has received speaking; cardiology; cardiovascular; clinical outcomes; grant money unrelated to this project from Nestle Health Science and Abbott; heart failure; honoraria and research support from Nestle Health Science, Abbott Nutrition, and; malnutrition; no role in data collection, analysis, interpretation, writing of the manuscript; nutritional support; relevant to the contents of this paper to disclose