Individualized nutritional support reduces death, CV events in heart failure patients

Implementation of an individualized nutritional support lowers the risk of mortality and major cardiovascular (CV) events compared with standard hospital food among hospitalized patients with chronic heart failure at high nutritional risk, suggests a study.

“Deterioration of nutritional status during hospitalization in patients with chronic heart failure increases mortality,” the investigators said.

To examine the effect of nutritional support on mortality, 645 patients with chronic heart failure (36 percent with acute decompensation) were enrolled in the investigator-initiated, open-label EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients) trial.

The investigators randomized patients to protocol-guided individualized nutritional support to reach energy, protein, and micronutrient goals (intervention group) or to standard hospital food (control group). All-cause mortality at 30 days was the primary endpoint.

An increase in mortality over 180 days was noted with higher severity of malnutrition (odds ratio [OR] per 1-point increase in Nutritional Risk Screening 2002 score, 1.65, 95 percent confidence interval [CI], 1.21–2.24; p=0.001).

At day 30, significantly fewer patients in the intervention group died compared to those in the control group (27 of 321 [8.4 percent] vs 48 of 324 [14.8 percent]; OR, 0.44, 95 percent CI, 0.26–0.75; p=0.002). Patients at high nutritional risk appeared to benefit the most from nutritional support.

At 180-day follow-up, mortality effects remained significant. In addition, patients in the intervention group had a lower risk for major CV events at 30 days than those in the control group (17.4 percent vs 26.9 percent, OR, 0.50, 95 percent CI, 0.34–0.75; p=0.001).

“These data support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this vulnerable patient population,” the investigators said.