Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure

被引：131

作者：

Hersberger, Lara ^{[1
,2
]}

Dietz, Anna ^{[1
,2
]}

Burgler, Helene ^{[1
,2
]}

Bargetzi, Annika ^{[1
,2
]}

Bargetzi, Laura ^{[1
,2
]}

Kagi-Braun, Nina ^{[1
]}

Tribolet, Pascal ^{[3
]}

Gomes, Filomena ^{[1
,4
]}

Hoess, Claus ^{[5
]}

Pavlicek, Vojtech ^{[5
]}

Bilz, Stefan ^{[6
]}

Sigrist, Sarah ^{[6
]}

Brandle, Michael ^{[6
]}

Henzen, Christoph ^{[7
]}

Thomann, Robert ^{[8
]}

Rutishauser, Jonas ^{[9
]}

Aujesky, Drahomir ^{[10
]}

Rodondi, Nicolas ^{[10
,11
]}

Donze, Jacques ^{[10
,12
]}

Stanga, Zeno ^{[13
]}

Mueller, Beat ^{[1
,2
]}

Schuetz, Philipp ^{[1
,2
]}

机构：

[1] Kantonsspital Aarau, Med Univ Dept, Div Gen Internal & Emergency Med, Aarau, Switzerland

[2] Univ Basel, Med Fac, Basel, Switzerland

[3] Spital Lachen, Internal Med, Oberdorf, Switzerland

[4] New York Acad Sci, New York, NY USA

[5] Kantonsspital Muensterlingen, Internal Med, Muensterlingen, Switzerland

[6] Kantonsspital St Gallen, Internal Med & Endocrinol Diabet, St Gallen, Switzerland

[7] Kantonsspital Luzern, Internal Med, Luzern, Switzerland

[8] Buergerspital Solothurn, Dept Internal Med, Solothurn, Switzerland

[9] Kantonsspital Baden, Internal Med, Baden, Switzerland

[10] Univ Bern, Bern Univ Hosp, Inselspital, Dept Gen Internal Med, Bern, Switzerland

[11] Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland

[12] Brigham & Womens Hosp, Div Gen Internal Med, 75 Francis St, Boston, MA 02115 USA

[13] Univ Bern, Bern Univ Hosp, Inselspital, Div Diabetol Endocrinol Nutr Med & Metab, Bern, Switzerland

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2021年 / 77卷 / 18期

基金：

瑞士国家科学基金会;

关键词：

KEY WORDS cardiology; cardiovascular; clinical outcomes; heart failure; malnutrition; Nutritional Risk Screening; nutritional support; DIETARY-SODIUM RESTRICTION; MEDICAL INPATIENTS; EUROPEAN-SOCIETY; RISK; ASSOCIATION; MALNUTRITION; CARDIOLOGY; MANAGEMENT; MORTALITY; OUTCOMES;

D O I：

10.1016/j.jacc.2021.03.232

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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) (J Am Coll Cardiol 2021;77:2307-19) (c) 2021 by the American College of Cardiology Foundation.

引用

页码：2307 / 2319

页数：13

共 43 条

[1] Nutritional Interventions in Heart Failure: A Systematic Review of the Literature [J].

Abshire, Martha ;

Xu, Jiayun ;

Baptiste, Diana ;

Almansa, Johana R. ;

Xu, Jingzhi ;

Cummings, Abby ;

Andrews, Martha J. ;

Himmelfarb, Cheryl Dennison .

JOURNAL OF CARDIAC FAILURE, 2015, 21 (12) :989-999

[2] Nutrition intervention in heart failure: should consumption of the DASH eating pattern be recommended to improve outcomes? [J].

Abu-Sawwa, Renad ;

Dunbar, Sandra B. ;

Quyyumi, Arshed A. ;

Sattler, Elisabeth L. P. .

HEART FAILURE REVIEWS, 2019, 24 (04) :565-573

[3] Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein-Energy Malnutrition [J].

Adejumo, Adeyinka Charles ;

Adejumo, Kelechi Lauretta ;

Adegbala, Oluwole Muyiwa ;

Enwerem, Ngozi ;

Ofosu, Andrew ;

Akanbi, Olalekan ;

Fijabi, Daniel Obadare ;

Ogundipe, Olumuyiwa Akinbolaji ;

Pani, Lydie ;

Adeboye, Adedayo .

JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, 2020, 44 (03) :454-462

[4] ESPEN guidelines on enteral nutrition:: Cardiology and pulmonology [J].

Anker, S. D. ;

John, M. ;

Pedersen, P. U. ;

Raguso, C. ;

Cicoira, M. ;

Dardai, E. ;

Laviano, A. ;

Ponikowski, P. ;

Schols, A. M. W. J. ;

Becker, H. F. ;

Boehm, M. ;

Brunkhorst, F. M. ;

Vogelmeier, C. .

CLINICAL NUTRITION, 2006, 25 (02) :311-318

[5] ESPEN Guidelines on Parenteral Nutrition: On Cardiology and Pneumology [J].

Anker, S. D. ;

Laviano, A. ;

Filippatos, G. ;

John, M. ;

Paccagnella, A. ;

Ponikowski, P. ;

Schols, A. M. W. J. .

CLINICAL NUTRITION, 2009, 28 (04) :455-460

[6]

Aquilani R, 2008, EUR J HEART FAIL, V10, P1127, DOI 10.1016/j.ejheart.2008.09.002

[7] Nutritional Intervention in Malnourished Hospitalized Patients with Heart Failure [J].

Bonilla-Palomas, Juan L. ;

Gamez-Lopez, Antonio L. ;

Castillo-Dominguez, Juan C. ;

Moreno-Conde, Mirian ;

Lopez Ibanez, Marla C. ;

Alhambra Exposito, Rosa ;

Ramiro Ortega, Esmeralda ;

Anguita-Sanchez, Manuel P. ;

Villar-Raez, Antonia .

ARCHIVES OF MEDICAL RESEARCH, 2016, 47 (07) :535-540

[8] Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines [J].

Bounoure, Lisa ;

Gomes, Filomena ;

Stanga, Zeno ;

Keller, Ulrich ;

Meier, Remy ;

Ballmer, Peter ;

Fehr, Rebecca ;

Mueller, Beat ;

Genton, Laurence ;

Bertrand, Pauline Coti ;

Norman, Kristina ;

Henzen, Christoph ;

Laviano, Alessandro ;

Bischoff, Stephan ;

Schneider, Stephane M. ;

Kondrup, Jens ;

Schuetz, Philipp .

NUTRITION, 2016, 32 (7-8) :790-798

[9] Complex Energy Metabolic Changes in Heart Failure With Preserved Ejection Fraction and Heart Failure With Reduced Ejection Fraction [J].

De Jong, Kirstie A. ;

Lopaschuk, Gary D. .

CANADIAN JOURNAL OF CARDIOLOGY, 2017, 33 (07) :860-871

[10] Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial [J].

Deutz, Nicolaas E. ;

Matheson, Eric M. ;

Matarese, Laura E. ;

Luo, Menghua ;

Baggs, Geraldine E. ;

Nelson, Jeffrey L. ;

Hegazi, Refaat A. ;

Tappenden, Kelly A. ;

Ziegler, Thomas R. .

CLINICAL NUTRITION, 2016, 35 (01) :18-26

← 1 2 3 4 5 →