Characteristics and prognostic significance of nutritional status in frail patients with chronic heart failure

Abstract Malnutrition is associated with an increased risk of mortality in patients with chronic heart failure (CHF). However, the nutritional habits of frail patients with CHF and its relationship with the different severity of domains of senile asthenia has not been sufficiently studied. Aim: To evaluate the nutritional status according to CONUT score in patients with CHF depending on the domains of frailty syndrome. Materials and methods: A prospective study included 150 patients over 75 years (median age [IQR] 83.0 [77.8-87.0] years, 38% (n=57) men) admitted to a multidisciplinary hospital for CHF decompensation, who were assessed for the prevalence of HFA-ESC domains (2019) – clinical, psycho-cognitive, functional and social. Nutritional status was assessed according to the CONUT score. The combined endpoint was a combination of death from all causes and repeated hospitalizations for CHF within 1 year after discharge from the hospital. Results: 96.7% (n=145) of senile patients with CHF had at least one domain of senile asthenia, the presence of all four domains was observed in more than a third of patients. Disorders in the psycho-cognitive and social spheres were the most common – 88.7% (n=133) and 74.0% (n=111), respectively, and clinical and functional domains were less common in 64.0% (n=96) and 56.7% (n=85) of patients, respectively. The presence of all four domains of frailty syndrome increases the risk of combined events from the primary endpoint by 2.5 times (OR 2.5; 95% CI 1.1-5.7, p<0.05), hospital mortality by 14.7 times (OR 14.7; 95% CI 3.3-66.4, p<0.05). The median CONUT score increased with multiple frailty domains. – 2,5±1,6, 3,2±2,5, 3,7±2,7, 3,8±2,6 and 4.6±2.9 points for 0, 1, 2, 3 and 4 domains of frailty syndrome, respectively. The CONUT score correlated with the IL-6 level (r=0.510, p<0.001). With a CONUT score ≥2, senile patients with CHF had an increased chance of an unfavorable outcome both in the short term – hospital mortality increased by 5 times (OR 5.3, 95% CI 1.6–40.7, p<0.05), and within 12 months – death from CHF or repeated hospitalization for CHF within 1 year after discharge from the hospital increased almost by 4 times (OR 3.8, 95% CI 1.2-11.6, p<0.05). Conclusion: The worst indicators of nutritional status in patients with CHF are associated with a more frequent combination of several domains of frailty syndrome. Determination of nutritional status with the CONUT score in patients with CHF is a justified method for identifying a high-risk group of unfavorable outcomes.