Assessing malnutrition to prevent mortality in patients with advanced heart failure: Hades study

Altough malnutrition has been associated with higher mortality in heart failure (HF), information about its impact on community-dwelling older patients with advanced HF remains scarce.

This study is aimed at determining the prevalence and impact of malnutrition in the mortality of patients with advanced HF.

A prospective multicenter study included a cohort of community-dwelling older patients with HF in New York Heart Association IV (NYHA) functional status, or those in NYHA III who had needed hospitalisation at least twice in the previous six months.

A total of 22 primary healthcare centres, two university hospitals, one acute-care hospital, and one geriatric rehabilitation unit, participated in the study.

To evaluate nutritional status, the MNA-SF seven-item questionnaire was administered. When the scores were lower than eleven points, an additional questionnaire classified patients into two categories: risk of malnutrition or established malnutrition

A total of 271 patients with HF were included. Women constituted 59.8%, and mean age was 84.2 years (SD 8.3). Patients older than 65 years represented 98.1% of the sample. Median follow-up was 14.9 months (percentile 25-75; 4.9-26.9). Malnutrition risk was observed in 127 and confirmed malnutrition in 33 patients. During follow-up, 134 of the included participants died.

Comorbidity was not observed to be determinant in either malnutrition risk or mortality.

The multivariate model adjusted by sex, age, and Body Mass Index showed that established malnutrition was an independent risk factor for mortality (Odds Ratio 2.91, 95% Confidence Interval 1.14; 8.22)

In a cohort of community-dwelling older patients with advanced HF, malnutrition has been associated with higher rates of mortality. Malnutrition risk should be systematically addressed by primary care healthcare professionals to improve survival rates in these patients