Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure

Backgrounds: The Get with The Guidelines (GWTG) heart failure (HF) risk score was developed in the GWTG inpatient HF registry to predict in-hospital mortality and has been recently reported to be associated with post-discharge long-term outcomes. Malnutrition is associated with poor outcome in ADHF patients. However, there is no information available on the long-term prognostic significance of the combination of GWTG-HF risk score and malnutrition in patients admitted for ADHF, relating to reduced left ventricular ejection fraction (LVEF). Methods: We studied 303 ADHF patients discharged with survival (HFrEF(LVEF<40%); n=180, HFpEF(LVEF≥40%;n=123). At the admission, we evaluated GWTG-HF score and nutritional status. Variables required for the GWTG-HF risk score were race, age, systolic blood pressure, heart rate, serum levels of blood urea nitrogen and sodium, and the presence of chronic obstructive pulmonary disease. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89 · serum albumin (g/dl) + 41.7 · BMI/22, and malnutrition was defined as GNRI<92. The study endpoint was cardiovascular-renal poor outcome (CVR), defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. Results: During a follow-up period of 4.2±3.3 yrs, 86 patients had CVR. At multivariate Cox analysis, GWTG-HF risk score and GNRI were significantly and independently associated with CVR, in both HFrEF and HFpEF groups. The patients with both greater GWTG-HF score (>median value=35) and malnutrition had a significantly increased risk of CVR than those with either and none of them ([HFrEF] 60% vs 32% vs 16%, p<0.0001, [HFpEF] 45% vs 18% vs 12%, p<0.0001, respectively) Conclusion: Malnutrition assessed by GNRI would provide the additional long-term prognostic information to GWTG-HF risk score in patients admitted for ADHF, irrespective of the presence of reduced LV function.

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Geriatric Nutritional Risk Index at Hospital Discharge Is a Useful Predictor of Adverse Outcome in Hospitalized Patients with Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2017.08.138 ◽

2017 ◽

Vol 23 (10) ◽

pp. S32

Author(s):

Masafumi Ono ◽

Atsushi Mizuno ◽

Ryoma Fukuoka ◽

Yasuyuki Shiraishi ◽

Takashi Kohno ◽

...

Keyword(s):

Heart Failure ◽

Hospital Discharge ◽

Adverse Outcome ◽

Risk Index ◽

Hospitalized Patients ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Nutritional Risk Index ◽

Patients With Heart Failure

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Impact of Malnutrition Using Geriatric Nutritional Risk Index in Heart Failure With Preserved Ejection Fraction

JACC Heart Failure ◽

10.1016/j.jchf.2019.06.002 ◽

2019 ◽

Vol 7 (8) ◽

pp. 676-677

Author(s):

Andrew L. Clark ◽

Shirley Sze

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Risk Index ◽

Nutritional Risk ◽

Preserved Ejection Fraction ◽

Geriatric Nutritional Risk Index ◽

Nutritional Risk Index

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Geriatric Nutritional Risk Index Might Predict All-Cause Deaths in Elderly Patients With Heart Failure With Preserved Ejection Fraction Requiring Hospitalization

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2017.08.401 ◽

2017 ◽

Vol 23 (10) ◽

pp. S79-S80

Author(s):

Isao Nishi ◽

Yoshihiro Seo ◽

Yoshie Hamada ◽

Kimi Sato ◽

Seika Sai ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Elderly Patients ◽

Risk Index ◽

Nutritional Risk ◽

Preserved Ejection Fraction ◽

Geriatric Nutritional Risk Index ◽

Nutritional Risk Index ◽

Patients With Heart Failure

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Prognostic Impact of Change in Nutritional Risk on Mortality and Heart Failure After Transcatheter Aortic Valve Replacement

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009342 ◽

2021 ◽

Vol 14 (2) ◽

Author(s):

Rocío González Ferreiro ◽

Diego López Otero ◽

Leyre Álvarez Rodríguez ◽

Óscar Otero García ◽

Marta Pérez Poza ◽

...

Keyword(s):

Heart Failure ◽

Transcatheter Aortic Valve Replacement ◽

Risk Index ◽

Nutritional Risk ◽

Prognostic Impact ◽

Geriatric Nutritional Risk Index ◽

Transcatheter Aortic Valve ◽

Risk Of Mortality ◽

Nutritional Risk Index

Background: Limited data are available regarding change in the nutritional status after transcatheter aortic valve replacement (TAVR). This study evaluated the prognostic impact of the change in the geriatric nutritional risk index following TAVR. Methods: TAVR patients were analyzed in a prospective and observational study. To analyze the change in nutritional status, geriatric nutritional risk index of the patients was calculated on the day of TAVR and at 3-month follow-up. The impact of the change in nutritional risk index after TAVR on all-cause mortality, heart failure hospitalization (HF-h), and the composite of all-cause death and HF hospitalization was analyzed using the Cox Proportional Hazards model. Results: Four hundred thirty-three patients were included. After TAVR, 68.4% (n=182) patients with baseline nutritional risk improved compared with 31.6% (n=84) who remained at nutritional risk. The change from no-nutritional risk to nutritional risk after TAVR occurred in 15.0% (n=25), while 85.0% (n=142) remained without risk of malnutrition. During follow-up, 157 (36.3%) patients died and 172 patients (39.7%) were hospitalized due to HF. Patients who continued to be at nutritional risk had a higher risk of mortality (hazard ratio [HR], 2.10 [95% CI, 1.30–3.39], P =0.002), HF-h (HR, 1.97 [95% CI, 1.26–3.06], P =0.000), and the composite of death and HF-h (HR, 2.0 [95% CI, 1.37–2.91], P <0.001). The change to non-nutritional risk after TAVR significantly impacted mortality (HR, 0.48 [95% CI, 0.30–0.78], P =0.003), HF-h (HR, 0.50 [95% CI, 0.34–0.74], P =0.001), and the composite outcome (HR, 0.44 [95% CI, 0.32–0.62], P <0.001). Conclusions: Remaining at nutritional risk after TAVR confers a poor prognosis and is associated with an increased risk of mortality and HF-h, while the change from risk of malnutrition to non-nutritional risk after TAVR was associated with a halving of the risk of mortality and HF-h. Further studies are needed to identify whether patients at nutritional risk would benefit from nutritional intervention during processes of care of TAVR programs.

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