Nutrition assessment in advanced heart failure patients evaluated for ventricular assist devices or cardiac transplantation.

BACKGROUND: Malnutrition has been shown to affect clinical outcomes in patients with heart failure. The aim of this study was to analyze the incidence of malnutrition and to assess its prognostic significance in patients with advanced heart failure (AHF) (being evaluated for left ventricular assist device [LVAD] or cardiac transplant) based on nutrition status as assessed by the Mini Nutritional Assessment (MNA). METHODS: A retrospective analysis was conducted on 154 patients. During evaluation, a complete nutrition assessment was performed, and diagnosis of malnutrition and risk of malnutrition was done with the MNA. Its possible independent association with mortality was assessed. RESULTS: The mean (SD) age of the patients was 59.3 (14.1) years, with 76% men. Twenty-two percent were classified as malnourished, 68% at risk of malnutrition, and 10% well nourished. The mortality in the 3 groups was 26.5%, 42.0%, and 6.7%, respectively (P = .02). In the multivariate logistic regression analysis, the undernutrition state (malnourished + at risk) was an independent predictor of mortality (odds ratio, 7.9; confidence interval, 1.01-62.30; P = .04). CONCLUSIONS: The state of undernutrition is an independent predictor of mortality in patients with AHF. Early recognition of undernutrition through use of the MNA may affect the long-term prognosis of these patients by enabling early intervention.

Pilot study evaluates nutrition for patients receiving mechanical circulatory support in the intensive care unit.

Establishing a nutrition protocol with an accompanying algorithm allows a multidisciplinary team to make decisions to maintain or improve nutrition-related outcomes during the intensive care unit (ICU) stay. This descriptive pilot study included subjects (N = 11) recruited from a convenient sample of patients admitted for surgical implantation of a mechanical circulatory support device. Nutritional and strength measures were compared across 3 time intervals: preoperatively, postoperative day 3, and within 48 hours of transfer from ICU. The mean age of the sample was 60 ± 8 years. Overall, subjects maintained preoperative nutritional status demonstrated by a nonsignificant change in the nutritional and strength measures from the preoperative period compared to transfer from ICU. The nutrition protocol with algorithm provided a step-by-step approach to ensure a consistent nutritional plan of care. It also standardized nutritional care while ensuring safe practice.