Possible sarcopenia and its association with hospital-associated dysphagia and decline in physical function: Findings from a heart failure patients prospective cohort study.

BACKGROUND & AIMS: There is limited evidence regarding the association of sarcopenia with dysphagia and physical function in patients with heart failure. This study examined the association between possible sarcopenia and both swallowing and physical function in individuals with acute heart failure (AHF). METHODS: This prospective cohort study included hospitalized patients with AHF. Possible sarcopenia was assessed on admission using calf circumference and grip strength according to an international diagnostic criteria. The primary outcome was dysphagia at discharge using the Food Intake Level Scale (FILS), and the secondary outcome was physical function at discharge using the Barthel Index (BI). Multiple regression analysis and logistic regression, adjusted for potential confounders, were used to examine the association between possible sarcopenia at admission and FILS and BI at discharge. RESULTS: A total of 320 patients (mean age 81.5 years; 170 women) were included in the analysis; 199 (59.4%) were diagnosed with possible sarcopenia. Multivariate analysis showed that possible sarcopenia at admission was significantly associated with FILS at discharge (ß = -0.1204; p = 0.039). Possible sarcopenia at admission was not significantly associated with BI at discharge (OR = 2.066; 95% CI, 0.910-4.692, p = 0.083). CONCLUSIONS: Possible sarcopenia was associated with decline in swallowing function during hospitalization in patients with AHF. These findings highlight the need for early detection and treatment of possible sarcopenia in this setting.

Association of poor oral health with increased incidence of dysphagia and impaired improvement in nutritional status among patients with acute heart failure: a prospective cohort study.

AIMS: This study aimed to clarify the association between oral health and the incidence of dysphagia as well as the recovery of nutritional status and improvement of dysphagia in hospitalized patients with acute heart failure. METHODS: Hospitalized patients with AHF were prospectively enrolled. Oral health was evaluated using the Japanese Version of the Oral Health Assessment Tool (OHAT-J) after circulation dynamics improved (defined as baseline), and participants were classified into good and poor oral health groups (OHAT-J 0-2 and ≧ 3, respectively). The primary outcome measure was the incidence of dysphagia evaluated using the Food Intake Level Scale (FILS) at baseline. Secondary outcome measures were nutritional status and FILS score at discharge. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF). Univariate and multivariate logistic regression analyses were used to determine the association between oral health and the study outcomes. RESULTS: Of the 203 recruited patients (mean age, 79.5 years; 50.7% female), 83 (40.9%) were in the poor oral health group. Participants with poor oral health were significantly older, had lower skeletal muscle mass and strength, lower nutrient intake and nutritional status, worse swallowing status, as well as lower cognitive level, and physical function than those with good oral health. In multivariate logistic regression analyses, baseline poor oral health was significantly associated with the incidence of dysphagia (odds ratio = 1.036, P = 0.020), as well as with the improvement in nutritional status (odds ratio = 0.389, P = 0.046) and dysphagia (odds ratio = 0.199, P = 0.026) at discharge. CONCLUSIONS: Poor baseline oral health was associated with the incidence of dysphagia, as well as with the lack of improvement in nutritional status and dysphagia in patients with acute heart failure.

Association of resting energy expenditure-based energy intake sufficiency with functional recovery, dysphagia, and 1-year mortality following heart failure: A prospective observational study.

AIM: Evidence for the influence of resting energy expenditure (REE)-based energy intake on the outcomes of patients with heart failure (HF) is scarce. This study evaluates the relationship between REE-based energy intake sufficiency and clinical outcomes in hospitalized HF patients. METHODS: This prospective observational study included newly admitted patients with acute HF. REE was measured using indirect calorimetry at baseline and total energy consumption (TEE) was calculated by multiplying REE with activity index. Energy intake (EI) was recorded, and the patients were classified into two groups, namely, the energy intake sufficiency (i.e., EI/TEE ≥1) and energy intake deficiency groups (i.e., EI/TEE <1). The primary outcome was the performance of activities of daily living, assessed using the Barthel Index, at discharge. Other outcomes included dysphagia at discharge and all-cause 1-year mortality following discharge. Dysphagia was defined as a Food Intake Level Scale (FILS) score of <7. Multivariable analyses and Kaplan-Meier estimates were used to determine the association of energy sufficiency both at baseline and at discharge with the outcomes of interest. RESULTS: The analysis included 152 patients (mean age, 79.7 years; 51.3% women); of them, 40.1% and 42.8% had inadequate energy intake both at baseline and at discharge, respectively. In multivariable analyses, energy intake sufficiency at discharge was significantly associated with the BI (ß = 0.136, p = 0.002) and FILS score (odds ratio = 0.027, p < 0.001) at discharge. Moreover, energy intake sufficiency at discharge was associated with 1-year mortality after discharge (p < 0.001). CONCLUSION: Adequate energy intake during hospitalization was associated with improved physical and swallowing functions and 1-year survival in HF patients. Adequate nutritional management is essential for hospitalized HF patients, suggesting that adequate energy intake may lead to optimal outcomes.

Role of systemic inflammation in functional recovery, dysphagia, and 1-y mortality in heart failure: A prospective cohort study.

OBJECTIVES: This study evaluated the relationship between systemic inflammation and clinical outcomes in people hospitalized with acute heart failure (AHF). METHODS: We prospectively enrolled people newly hospitalized with AHF after excluding those with concomitant infectious or inflammatory diseases. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS) at hospitalization, and participants were classified into low-grade and high-grade inflammation groups (mGPS 0-1 and 2, respectively). The primary outcome measure was functional recovery, evaluated using the Barthel Index gain. Secondary outcome measures were dysphagia at discharge and all-cause 1-y mortality after discharge. Multivariable analyses and Kaplan-Meier estimates were used to determine the association between systemic inflammation and study outcomes. RESULTS: A total of 184 participants (mean age, 79.1 y; 48.4% female, 51.6% male) were included; 148 (80.4%) and 36 (19.6%), respectively, had low-grade and high-grade inflammation. Participants with high-grade inflammation were significantly older, had lower body mass index and muscle strength, and had lower nutrient intake, swallowing status, and Barthel Index than those with low-grade inflammation. In multivariable analyses, mGPS was significantly associated with Barthel Index gain (ß = -0.229, P = 0.004) and Food Intake Level Scale (odds ratio = 5.067, P = 0.034) at discharge; mGPS was associated with 1-y mortality after discharge (P = 0.003). CONCLUSIONS: Baseline systemic inflammation was negatively associated with improvements in physical function and dysphagia and with 1-y survival in people with AHF. These findings highlight the importance of focusing on the assessment of systemic inflammation to accurately predict the functional prognosis of people with AHF.

Incidence of Dysphagia and Its Association With Functional Recovery and 1-Year Mortality in Hospitalized Older Patients With Heart Failure: A Prospective Cohort Study.

PURPOSE: Dysphagia following heart failure (HF) has gained little attention. This study aimed to evaluate the incidence of dysphagia and its associations with the clinical outcomes in HF patients. METHODS: This prospective cohort study included 203 consecutive hospitalized HF patients (mean age 79.5 years, 103 women) without dysphagia before admission. Dysphagia or difficulty swallowing was assessed by the Food Intake Level Scale. The primary outcome was activity of daily living, as assessed by the Barthel Index (BI) at discharge. Secondary outcomes included all-cause mortality and rehospitalization rates at 1 year after discharge. Multivariate analyses and Kaplan-Meier estimates were used to determine whether dysphagia was associated with these outcomes. RESULTS: Of the 203 patients examined, 48 (23.4%) were diagnosed with dysphagia during admission. Patients who developed dysphagia were significantly older, exhibited lower muscle mass and strength, walked shorter distances, and had lower nutrition intake levels and BI scores (P < 0.05 for all values) compared with those without dysphagia. In the multivariate analyses, the presence of dysphagia at discharge was significantly associated with a lower BI (ß= -0.275, P < 0.001). Furthermore, patients with dysphagia showed a significantly higher 1-year mortality than those without (20.8% vs 1.2%, P = 0.008). CONCLUSIONS: Dysphagia commonly occurs during hospital admission and is associated with functional recovery and 1-year mortality in HF patients.

Dysphagia is associated with poor physical function in patients with acute heart failure: a prospective cohort study.

BACKGROUND: Dysphagia is an important clinical problem in older adults with heart failure. Moreover, evidence is scarce regarding the prevalence and impact of dysphagia on physical function in these patients. AIMS: This study examined the association of dysphagia and physical function in patients undergoing cardiac rehabilitation following heart failure. METHODS: This prospective cohort study included consecutive 149 (mean age 78.6 years, 72 women) inpatients in an acute-care hospital. Outcomes included the Food Intake Level Scale (FILS) and Barthel Index (BI) as indicators of dysphagia status and physical function, respectively. Multivariate analyses were used to determine whether FILS scores on admission and at the point of heart failure stabilization were associated with BI at discharge. RESULTS: Of the 149 patients, 14 (9.4%) had dysphagia at the time of stabilization of heart failure. Patients with dysphagia (FILS score < 7) were significantly older, more demented, exhibited lower muscle mass and strength, walked shorter distances, and had lower energy and protein intakes, longer length of stay, and lower BI scores (all, p < 0.05) compared to those without dysphagia. Multiple regression analyses showed that FILS score was independently associated with BI at discharge (ß = 0.364, p < 0.001). CONCLUSIONS: Dysphagia was associated with declined physical function in patients undergoing cardiac rehabilitation following heart failure. Early detection and management of dysphagia can promote timely functional recovery in these patients.

Risk of malnutrition is associated with poor physical function in patients undergoing cardiac rehabilitation following heart failure.

AIM: Patients who experience heart failure are prone to malnutrition. The aim of this study was to determine the association between risk of malnutrition and physical function in patients undergoing cardiac rehabilitation following heart failure. METHODS: A cross-sectional study was performed in consecutive patients hospitalised for cardiac rehabilitation following heart failure. Risk of malnutrition was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF). Physical function was evaluated using the Barthel index (BI). Univariate and multivariate analyses were used to determine whether nutritional status was associated with BI in these patients. RESULTS: The present study included 105 patients (mean age of 77.3 years, 56 men and 49 women) for analysis. The median (interquartile range) scores of the MNA-SF and BI were 11 (9-13) and 75 (45-90), respectively. Patients with high risk of malnutrition (MNA-SF score < 7) were significantly older, had a lower body mass index, exhibited lower muscle mass and strength, could walk shorter distances, and had lower BI scores (all P < 0.05). On multivariate analysis, the MNA-SF score was independently associated with BI (ß = 0.409, P < 0.001) after adjusting for age, sex, muscle mass and strength, brain natriuretic peptide levels, ejection fraction of the left ventricle, and reason for admission. CONCLUSIONS: Risk of malnutrition is associated with physical function in patients undergoing cardiac rehabilitation following heart failure. Early detection of malnutrition and commencement of nutritional support may improve functional recovery in these patients.