Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Heart Failure Reports
Published in: Current Heart Failure Reports 2/2014

01-06-2014 | Management of Heart Failure (TE Meyer, Section Editor)

The Importance of Assessing Nutritional Status in Elderly Patients with Heart Failure

Authors: Luis Sargento, Susana Longo, Nuno Lousada, Roberto Palma dos Reis

Published in: Current Heart Failure Reports | Issue 2/2014

Login to get access

Abstract

Heart failure (HF) is a syndrome characterized by high morbidity and mortality, despite advances in medical and device therapy that have significantly improved survival. The outcome of HF in elderly patients results from a combination of biological, functional, psychological, and environmental factors, one of which is nutritional status. Malnutrition, as well as HF, is frequently present with aging. Early detection might lead to earlier intervention. It is our goal to review the importance of nutritional status in elderly patients with HF, as well as tools for assessing it. We also propose a simple decision algorithm for the nutritional assessment of elderly patients with HF.
Literature
1.
Lindenfeld J, Albert NM, Boehmer JP, et al. Executive Summary: HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010;16:475–539.CrossRef
2.
Krim SR, Campbell P, Lavie CJ, Ventura H. Micronutrients in chronic heart failure. Curr Heart Fail Rep. 2013;10(1):46–53.PubMedCrossRef
3.
Heart disease and stroke statistics—2011 update. A report from the American Heart Association. Circulation. 2011;123:e18–209.CrossRef
4.
Roger VL, Weston SA, Redfield MM, et al. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292(3):344–50.PubMedCrossRef
5.
Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347:1397–402.PubMedCrossRef
6.
Kulminski AM, Ukraintseva SV, Kulminskaya IV, et al. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc. 2008;56:898–903.PubMedCentralPubMedCrossRef
7.
Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010;5:207–16.PubMedCentralPubMed
8.
Vischer UM, Frangos E, Graf C, et al. The prognostic significance of malnutrition as assessed by the Mini Nutritional Assessment (MNA) in older hospitalized patients with a heavy disease burden. Clin Nutr. 2012;31(1):113–7.PubMedCrossRef
9.
Foley NC, Salter KL, Robertson J, Teasell RW, Woodbury MG. Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke. 2009;40:e66–74.PubMedCrossRef
10.•
Pilotto A, Addante F, Franceschi M, et al. Multidimensional Prognostic Index based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure. Circ Heart Fail. 2010;3:14–20. Although the Multidimensional Prognostic Index is not a nutritional scoring system, it is a comprehensive multidimensional assessment for geriatric patients with HF. PubMedCentralPubMedCrossRef
11.
Gastelurrutia P, Lupon J, Domingo M, et al. Usefulness of body mass index to characterize nutritional status in patients with heart failure. Am J Cardiol. 2011;108:1166–70.PubMedCrossRef
12.
Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol. 2004;43:1439–44.PubMedCrossRef
13.
Kalantar-Zadeh K, Anker SD, Horwich T, Fonarow GC. Nutritional and anti-inflammatory interventions in chronic heart failure. Am J Cardiol. 2008;101(suppl):89E–103E.PubMedCrossRef
14.
Anker SD, Ponikowski P, Varney S, et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet. 1997;349:1050–3.PubMedCrossRef
15.
Berkowitz D, Croll MN, Likoff W. Malabsorption as a complication of congestive heart failure. Am J Cardiol. 1963;11:43–7.PubMedCrossRef
16.
Bauer JM, Kaiser MJ, Sieber CC. Evaluation of nutritional status in older persons: nutritional screening and assessment. Curr Opin Clin Nutr Metab Care. 2010;13:8–13.PubMedCrossRef
17.•
Gastelurrutia P, Lupón J, Domingo M, et al. Usefulness of body mass index to characterize nutritional status in patients with heart failure. Am J Cardiol. 2011;108(8):1166–70. This article confirms that BMI does not indicate true nutritional status in patients with HF. PubMedCrossRef
18.
Castillo-Martínez L, Colín-Ramírez E, Orea-Tejeda A, et al. Cachexia assessed by bioimpedance vector analysis as a prognostic indicator in chronic stable heart failure patients. Nutrition. 2012;28:886–91.PubMedCrossRef
19.•
Casas-Vara A, Santolaria F, Fernández-Bereciartúa A, et al. The obesity paradox in elderly patients with heart failure: analysis of nutritional status. Nutrition. 2012;28(6):616–22. This report confirms the obesity paradox in elderly patients with HF. PubMedCrossRef
20.
Oreopoulos A, Padwal R, Kalantar-Zadeh K, et al. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156:13–22.PubMedCrossRef
21.
Nagarajan V, Cauthen CA, Starling RC, Tang WH. Prognosis of morbid obesity patients with advanced heart failure. Congest Heart Fail. 2013;19(4):160–4.PubMedCrossRef
22.
Nescolarde L, Gastelurrutia P, Calpe J, et al. Comment on “Is bioelectrical impedance vector analysis of value in the elderly with malnutrition and impaired functionality?”. Nutrition. 2009;25:370–1.PubMedCrossRef
23.
Anker SD, Ponikowski PP, Clark AL, et al. Cytokine and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure. Eur Heart J. 1999;20:683–93.PubMedCrossRef
24.••
Fulster S, Tacke M, Sandek A, et al. Muscle wasting in patients with chronic heart failure: results from the studies investigating comorbidities aggravating heart failure (SICA-HF). Eur Heart J. 2013;34:512–9. This paper evaluates the relationship between wasting and the functional status of patients with chronic HF. Patients with muscle wasting have reduced exercise capacity (6-minute walk time and peak VO2), muscle strength, and left ventricle ejection fraction. PubMedCrossRef
25.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–21.PubMedCrossRef
26.
Yamauti AK, Ochiai ME, Bifulco PS, et al. Subjective global assessment of nutritional status in cardiac patients. Arq Bras Cardiol. 2006;87:772–7.PubMedCrossRef
27.
Malnutrition Advisory Group (MAG). MAG guidelines for detection and management of malnutrition. Redditch: British Association for Parenteral and Enteral Nutrition; 2000.
28.
Kondrup J, Rasmussen HH, Hamberg O, Ad SZ, Hoc ESPEN. Working Group. Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22:321–36.PubMedCrossRef
29.
Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15:116–22.PubMedCrossRef
30.
Neelemaat F, Kruizenga HM, de Vet HC, et al. Screening malnutrition in hospital outpatients. Can the SNAQ malnutrition screening tool also be applied to this population? Clin Nutr. 2008;27:439–46.PubMedCrossRef
31.••
Al-Najjar Y, Clark AL. Predicting outcome in patients with left ventricular systolic chronic heart failure using a nutritional risk index. Am J Cardiol. 2012;109(9):1315–20. This easy-to-use nutritional scoring system includes serum albumin and weight. Based on NRI scores, 23 % of patients are at risk for malnutrition. The score is a univariable predictor of mortality. PubMedCrossRef
32.
Naber TH, Schermer T, de Bree A, et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr. 1997;66:1232–9.PubMed
33.
Baker JP, Detsky AS, Wesson DE, et al. A comparison of clinical judgment and objective measurements. N Engl J Med. 1982;306:969–72.PubMedCrossRef
34.
Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr. 2004;92:799–808.PubMedCrossRef
35.••
Nochioka K, Sakata Y, Takahashi J, et al. CHART-2 Investigators. Prognostic impact of nutritional status in asymptomatic patients with cardiac diseases: a report from the CHART-2 Study. Circ J. 2013;77(9):2318–26. The CONUT score includes serum albumin, total cholesterol, and lymphocyte count. In this study, it was applied in patients with stage B HF. Poor nutritional status was associated with an increased incidence of death in the entire CHART-2 population and with the risk of hospitalization in the elderly population. PubMedCrossRef
36.
Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multidimensional prognostic index for 1-year mortality from the comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res. 2008;11:151–61.PubMedCentralPubMedCrossRef
37.••
Sargento L, Satendra M, Almeida I, et al. Nutritional status of geriatric outpatients with systolic heart failure and its prognostic value regarding death or hospitalization, biomarkers and quality of life. J Nutr Health Aging. 2013;17:300–4. There is good agreement between the MNA full and short forms. The MNA score correlated significantly with the patient’s quality of life and levels of N-terminal pro-brain natriuretic peptide and albumin. The short-form MNA was a predictor of outcome. PubMedCrossRef
38.••
Bonilla-Palomas JL, Gámez-López AL, Anguita-Sánchez MP, et al. Impact of malnutrition on long-term mortality in hospitalized patients with heart failure. Rev Esp Cardiol. 2011;64(9):752–8. Malnutrition and the risk of malnutrition, as evaluated with the MNA, are highly prevalent (13.0 % and 59.6 %) in patients hospitalized for HF. The nutritional status, as classified by the MNA, was associated with survival. CrossRef
39.••
Aggarwal A, Kumar A, Gregory MP, et al. Nutrition assessment in advanced heart failure patients evaluated for ventricular assist devices or cardiac transplantation. Nutr Clin Pract. 2013;28:112–9. Malnutrition is prevalent, as assessed with the MNA, in patients with advanced HF (being evaluated for ventricular-assisted devices or cardiac transplantation) and is an independent predictor of mortality. PubMedCrossRef
40.
Vellas B, Villars H, Abellan G, et al. Overview of the MNA—its history and challenges. J Nutr Health Aging. 2006;10(6):456–63.PubMed
41.
Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature—what does it tell us? J Nutr Health Aging. 2006;10(6):466–85.PubMed
42.
Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 2002;18:737–57.PubMedCrossRef
43.
Bauer JM, Kaiser MJ, Anthony P, Guigoz Y, Sieber CC. The Mini Nutritional Assessment—its history, today's practice, and future perspectives. Nutr Clin Pract. 2008;23(4):388–96.PubMedCrossRef
44.
Tsai AC, Chang TL, Wang YC, et al. Population-specific short-form mini nutritional assessment with BMI or calf-circumference can predict risk of malnutrition in community-living or institutionalized elderly in Taiwan. J Am Diet Assoc. 2010;110:1328–34.PubMedCrossRef
45.
Tsai AC, Chou YT, Chang TL, et al. A modified mini nutritional assessment without BMI can effectively assess the nutritional status of neuropsychiatric patients. J Clin Nurs. 2009;18:1916–22.PubMedCrossRef
46.
Kuzuya M, Kanda S, Koike T, et al. Evaluation of mini-nutritional assessment for Japanese frail elderly. Nutrition. 2005;21:498–503.PubMedCrossRef
47.
Tsai AC, Chang TL, Yang T-W, et al. A modified mini nutritional assessment without BMI predicts nutritional status of community-living elderly in Taiwan. J Nutr Health Aging. 2010;14:183–9.PubMedCrossRef
48.
Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56:M366–72.PubMedCrossRef
49.
Kaiser MJ, Bauer JM, Uter W, et al. Validation of the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13(9):782–8.PubMedCrossRef
50.
Poulia KA, Yannakoulia M, Karageorgou D, et al. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr. 2012;31:378–85.PubMedCrossRef
51.••
Kinugasa Y, Kato M, Sugihara S, et al. Geriatric Nutritional Risk Index predicts functional dependency and mortality in patients with heart failure with preserved ejection fraction. Circ J. 2013;77:705–11. This is the only paper evaluating the nutritional status of patients with HF with preserved left ventricular ejection fraction. The authors applied the GNRI score (serum albumin and BMI). There was an association with prognosis. PubMedCrossRef
52.•
Zapatero A, Barba R, Gonzalez N, et al. Influence of obesity and malnutrition on acute heart failure. Rev Esp Cardiol. 2012;65(5):421–6. The authors used a huge national database of patients with acute HF and evaluated nutritional status (methodology not referenced, only the ICD-9-CM code) prevalence and its impact on the outcome at 30 days. PubMedCrossRef
Metadata
Title
The Importance of Assessing Nutritional Status in Elderly Patients with Heart Failure
Authors
Luis Sargento
Susana Longo
Nuno Lousada
Roberto Palma dos Reis
Publication date
01-06-2014
Publisher
Springer US
Published in
Current Heart Failure Reports / Issue 2/2014
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-014-0189-5

Other articles of this Issue 2/2014

Current Heart Failure Reports 2/2014 Go to the issue

Management of Heart Failure (TE Meyer, Section Editor)

Determinants of Survival Following Hospitalization for Acute Heart Failure

Pathophysiology: Neuroendocrine, Vascular, and Metabolic Factors (SD Katz, Section Editor)

Cardiovascular Responses to Heat Stress in Chronic Heart Failure

HOT TOPIC

Ethical Challenges of Deactivation of Cardiac Devices in Advanced Heart Failure

Management of Heart Failure (TE Meyer, Section Editor)

Decision-Making Under Uncertainty in Advanced Heart Failure

Management of Heart Failure (TE Meyer, Section Editor)

Interventions for Heart Failure Readmissions: Successes and Failures

Management of Heart Failure (TE Meyer, Section Editor)

Management of fulminant myocarditis: A diagnosis in search of its etiology but with therapeutic options
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits