Peculiarities and prognostic significance of nutritional status in fragile patients with chronic heart failure
Abstract. Despite the fact that various tools for screening and diagnostics of nutritional deficiency have been proposed previously, “gold” standard in this sphere has not been determined. Therefore, correct and convenient assessment of nutritional status in fragile patients with chronic heart failure (CHF) is of particular importance. The aim: to estimate nutritional status using CONUT scale and the impact of malnutrition on the prognosis in patients over 75 years old having CHF. Material and methods.158 patients with CHF over 75 years old – 96 (60.8%) female and 62 (39.8%) male patients (Me [IQR], age – 83.0 [77.8–87.0] years) were prospectively included in the study. All participants had their nutritional status determined using the CONUT scale and body composition using bioimpedance analysis. Composite endpoint included death from all causes and rehospitalizations for CHF within 1 year after discharge from the hospital, secondary endpoint included in-hospital mortality. Results. Normal nutritional status index (0–1 point on CONUT scale) was fixed only in 17.1% (n = 27) of the study participants. Nutritional deficiency was noted in 82.9% (n=131) of patients, from them light degree of malnutrition (2–4 points) was detected in 55.0% (n=72), moderate (5–8 points) – in 38.2% (n=50), severe (≥ 9 points) – in 6.8% (n=9) of those examined individuals. Patients with severe nutritional deficiency were characterized by marked symptoms of CHF, high degree of physical inactivity, and tendency to active cellular and skeletal muscle mass deficiency. With a score of ≥2 on the CONUT scale, the odds of in-hospital mortality increased five-fold (odds ratio 5.3; 95% confidence interval: 1.6–40.7; p <0.05), and death or rehospitalization for CHF within 1 year after discharge from the hospital – four-fold (odds ratio 3.8; 95% confidence interval: 1.2–11.6; p <0.05). Conclusion. Assessment of nutritional deficiency regardless of its severity (≥ 2 points on CONUT scale) in patients ≥75 years old with CHF allows us to identify a high-risk group for adverse outcomes.Moiseeva A.Yu., Al Autairi A, Chopanova A, Yakovenko V.A., Kobalava Zh.D.
Keywords
chronic heart failure
CONUT scale
frailty syndrome
fragility
malnutrition
nutritional status
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About the Authors
Alexandra Yu. Moiseyeva, MD, PhD (Medicine), assistant at the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine of the Medical institute, RUDN University. Address: 117292, Moscow, 61 Vavilova St.E-mail: moiseyeva.alexandra.y@yandex.ru
ORCID: https://orcid.org/0000-0003-0718-5258. Scopus ID: 57223845075. eLibrary SPIN: 1121-0207.
Abdullah Al Autairi, MD, postgraduate student of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine of the Medical institute, RUDN University. Address: 117292, Moscow, 61 Vavilova St.
E-mail: abd77032@gmail.com
ORCID: https://orcid.org/0009-0001-7596-7828. eLibrary SPIN: 5788-5147.
Aidzheren Chopanova, MD, postgraduate student of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine of the Medical institute, RUDN University. Address: 117292, Moscow, 61 Vavilova St.
E-mail: a.chopanova@mail.ru
ORCID: https://orcid.org/0009-0005-6931-3333
Valeria A. Yakovenko, MD, clinical resident in the specialty “Endocrinology” of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine of the Medical institute, RUDN University. Address: 117292, Moscow, 61 Vavilova St.
E-mail: ler.gor17@yandex.ru
ORCID: https://orcid.org/0009-0003-3473-2541
Zhanna D. Kobalava, MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine of the Medical Institute, RUDN University. Address: 117198, Moscow, 6 Mikloukho-Maklaya St.
E-mail: zkobalava@mail.ru
ORCID: https://orcid.org/0000-0002-5873-1768. Scopus ID: 7004399203. eLibrary SPIN: 9828-5409
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