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

BACKGROUND

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.

OBJECTIVES

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

METHODS

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.

RESULTS

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).

CONCLUSION

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.