Abstract
Background
Frailty and malnutrition are common in patients with heart failure (HF), and are associated with adverse outcomes. We studied the prognostic value of three malnutrition and three frailty indices in patients admitted acutely to hospital with HF.
Methods
265 consecutive patients [62% males, median age 80 (interquartile range (IQR): 72–86) years, median NTproBNP 3633 (IQR: 2025–6407) ng/l] admitted with HF between 2013 and 2014 were enrolled. Patients were screened for frailty using the Derby frailty index (DFI), acute frailty network (AFN) frailty criteria, and clinical frailty scale (CFS) and for malnutrition using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score and prognostic nutritional index (PNI).
Results
According to the CFS (> 4), DFI, and AFN, 53, 50, and 53% were frail, respectively. According to the GNRI (≤ 98), CONUT score (> 4), and PNI (≤ 38), 46, 46, and 42% patients were malnourished, respectively. During a median follow-up of 598 days (IQR 319–807 days), 113 patients died. One year mortality was 1% for those who were neither frail nor malnourished; 15% for those who were either malnourished or frail; and 65% for those who were both malnourished and frail. Amongst the malnutrition scores, PNI, and amongst the frailty scores, CFS increased model performance most compared with base model. A final model, including CFS and PNI, increased c-statistic for mortality prediction from 0.68 to 0.84.
Conclusion
Worsening frailty and malnutrition indices are strongly related to worse outcome in patients hospitalised with HF.
Similar content being viewed by others
References
McMurray JJ, Adamopoulos S, Anker SD, et.al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847
National Heart Failure Audit, April 2012–March 2013. http://www.uclacuk/nicor/audits/heartfailure/documents/annualreports/hfannual12-13pdf. Accessed 18.3.2016.
Parmar KR, Xiu PY, Chowdhury MR, Patel E, Cohen M (2015) In-hospital treatment and outcomes of heart failure in specialist and non-specialist services: a retrospective cohort study in the elderly. Open Heart 2:e000095
Maggioni AP, Dahlström U, Filippatos G et al (2013) EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 15:808–817
Walston J, Hadley EC, Ferrucci L et al (2006) Research agenda for frailty in older adults: Toward a better understanding of physiology and etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 54:991–1001
Narumi T, Arimoto T, Funayama A, et al (2013) The prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 62:307–313
Chaudhry SI, McAvay G, Chen S et al (2013) Risk factors for hospital admission among older persons with newly diagnosed heart failure: findings from the cardiovascular health study. J Am Coll Cardiol 61:635–642
Cacciatore F, Abete P, Mazzella F et al (2005) Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Investig 35:723–730
Lupon J, Gonzalez B, Santaeugenia S et al (2008) Prognostic implication of frailty and depressive symptoms in an outpatient population with heart failure. Rev Esp Cardiol 61:835–842
Blondé-Cynober F, Morineau G, Estrugo B, Fillie E, Aussel C, Vincent JP (2011) Diagnostic and prognostic value of brain natriuretic peptide (BNP) concentrations in very elderly heart disease patients: specific geriatric cut-off and impacts of age, gender, renal dysfunction, and nutritional status. Arch Gerontol Geriatr 52:106–110
Rahman A, Jafry S, Jeejeebhoy K, Nagpal AD, Pisani B, Agarwala R (2016) Malnutrition and cachexia in heart failure. J Parenter Enteral Nutr 40:475–486
Otaki M (1993) Surgical treatment of patients with cardiac cachexia. An analysis of factors affecting operative mortality. Chest 105:1347–1351
Rozentryt P, von Haehling S, Lainscak M et al (2010) The effects of a high-caloric protein- rich oral nutritiaonl supplement in patients with chronic heart failure and cachexia on quality of life, body composition and inflammation markers: a randomized, double-blind pilot study. J Cachex Sarcopenia Muscle 1:35–42
Lopez D, Flicker L, Dobson A (2012) Validation of the frail scale in a cohort of older Australian women. J Am Geriatr Soc 60:171–173
Subra J, Gillette-Guyonnet S, Cesari M, Oustric S, Vellas B; Platform Team (2012) The integration of frailty into clinical practice: Preliminary results from the Gérontopôle. J Nutr Health Aging 16:714–720
Ensrud KE, Ewing SK, Taylor BC et al (2008) Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 168:382–389
Fried LP, Tangen CM, Walston J, et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156
Ignacio de Ulíbarri J, González-Madroño A, de Villar NG et al (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20:38–45
Bouillanne O, Morineau G, Dupont C et al (2005) Geriatric nutritional risk index: a new index for evaluating at –risk elderly medical patients. Am J Clin Nutr 82:777–783
Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495
Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF (1980) Prognostic nutritional index in gastrointestinal surgery. Am J Surg 139:160–167
Alvares-da-Silva MR, Reverbel da Silveira T (2005) Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 21:113–117
Woodard J, Youde J, &, Bagshaw S (2014) Frailty Identification in Acute Medical Admissions. Age Ageing 43:i9
Acute frailty nework webpage. [Accessed March 3, 2016]; available at: http://www.acutefrailtynetwork.org.uk/uploads/files/1/Resource/SILVER_BOOK_FINAL_MAIN.pdf.
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
Bonilla-Palomas JF, Gamez-Lopez AL, Anguita-Sanchez MP et al (2011) Impact of malnutrition on long-term mortality in hospitalised patients with heart failure. Rev Esp Cardio 64:752–758
Aziz EF, Javed F, Pratap B et al (2011) Malnutrition as assessed by nutritional risk index is associate with worse outcome in patients admitted with acute decompensated heart failure: an ACAP-HF data analysis. Heart Int 6:e2
Afilalo J, Alexander KP, Mack MJ et al (2014) Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 63:747–762
Levine B, Kalman J, Mayer L, Fillit HM, Packer M (1990) Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 323:236–241
Heck PM, Dutka DP (2009) Insulin resistance and heart failure. Curr Heart Fail Rep 6:89–94
Anker SD, Chua TP, Ponikowski P et al (1997) Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia. Circulation 96:526–534
Anker SD, Morley JE (2015) Cachexia: a nutritional syndrome? J Cachexia Sarcopenia Muscle 6:269–271
De Vries NM, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Staal JB, Nijhuis-van der Sanden MW (2012) Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis. Ageing Res Rev 11:136–149
Witte KK, Nikitin NP, Parker AC et al (2005) The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure. Eur Heart J 26:2238–2244
Murad MH, Elamin KB, Abu Elnour NO et al (2011) Clinical review: The effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Endocrinol Metab 96:2997–3006
Rejnmark L, Avenell A, Masud T et al (2012) Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials. J Clin Endocrinol Metab 97:2670–2681
Cameron ID, Fairhall N, Langron C et al (2013) A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med 11:65
Aggarwal A, Kumar A, Gregory MP et al (2013) Nutrition assessment in advanced heart failure patients evaluated for ventricular assist devices or cardiac transplantation. Nutr Clin Pract 28:112–119
Yamauti AK, Ochiai ME, Bifulco PS et al (2006) Subjective global assessment of nutritional status in cardiac patients. Arq Bras Cardiol 87:772–777
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None declared.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Sze, S., Zhang, J., Pellicori, P. et al. Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction. Clin Res Cardiol 106, 533–541 (2017). https://doi.org/10.1007/s00392-017-1082-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-017-1082-5