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The controlling nutritional status score predicts outcomes of cardiovascular events in patients with heart failure with preserved ejection fraction.

ABSTRACT: BackgroundsThe relationship between cardiovascular outcomes and the Controlling Nutritional Status (CONUT) score in heart failure (HF) with preserved ejection fraction (HFpEF) patients is unknown. This study aimed to evaluate the relationship between the score and cardiovascular outcomes in HFpEF patients.Methods and resultsA total of 506 consecutive HFpEF patients were prospectively observed for up to 1500 days or until the occurrence of cardiovascular events. The mean age was 71.6 ± 9.4 years. Cardiovascular outcomes were compared between the CONUT score 0–1 group with a normal nutritional state (normal group), the CONUT score 2–4 group with a light degree of undernutrition (light group), and the CONUT score 5–8 group with a moderate degree of undernutrition (moderate group). In this study, there were no patients who scored 9–12, which was defined as a severe state of undernutrition. Overall, 238 cardiovascular events were observed during the follow-up period (median: 1159 days). Kaplan–Meier analysis showed that the moderate group was at higher risk of composite cardiovascular events than the normal group (P < 0.001) and the light group (P = 0.031). The analysis also showed that the light group was at higher risk of composite cardiovascular events than the normal group (P = 0.038). Multivariable Cox proportional hazards analysis with the significant factors from the univariate analysis showed that the CONUT score (hazard ratio: 1.12, 95% confidence interval: 1.03–1.21, P = 0.005) significantly predicted future cardiovascular events.ConclusionNutritional screening using the CONUT score may be useful for predicting cardiovascular events in HFpEF patients.

SUBMITTER: Komorita T

PROVIDER: S-EPMC7326720 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Project description:ObjectiveWe explored the prognostic significance of controlling nutritional status (CONUT) score in older adults with heart failure with preserved ejection fraction (HFpEF) and compared CONUT with other objective nutritional indices.MethodsThis is a single-center retrospective cohort study in older adult coronary artery disease patients undergoing HFpEF. Clinical data and laboratory results were collected before discharge. CONUT, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) were calculated according to the formula. The primary endpoint of this study was readmission due to heart failure and all-cause mortality in the first year after hospitalization.ResultsA total of 371 older adults were enrolled. All patients were discharged and followed up for 1 year, and readmission for heart failure was 26% while all-cause mortality was 20%. Compared with the none and mild malnutrition risk group, the readmission rate for heart failure (HF) within 1 year (36% vs. 18%, 23%) and all-cause mortality rate in the moderate and severe malnutrition risk group (40% vs. 8%, 0%) were higher (P < 0.05). On multivariate logistic analysis, CONUT was not associated with readmission due to HF within 1 year. CONUT was significantly associated with all-cause mortality independently of GNRI or PNI, after adjustment for major confounders including age, bedridden; length of stay; history of chronic kidney disease; loop diuretics use; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-adrenergic blocking agents use; New York Heart Association (NYHA) functional class; hemoglobin; potassium; Creatinine; triglycerides; glycosylated hemoglobin; brain natriuretic peptide; left ventricular ejection fraction; GNRI and PNI via multivariable Cox analysis (HR (95% CI) 1.764 (1.503, 2.071); 1.646 (1.359, 1.992); 1.764 (1.503, 2.071), respectively). Kaplan-Meier analysis revealed that the risk of all-cause mortality significantly increased in accordance with a higher CONUT (CONUT 5-12 compare to 0-1:HR (95% CI) 6.16 (3.78, 10.06); CONUT 2-4 compare to 0-1:HR (95% CI) 0.16 (0.10, 0.26)). CONUT showed the best area under the curve value (0.789) for the prediction of all-cause mortality compared with the other objective nutritional indices.ConclusionCONUT is a simple and strong prognostic indicator for the prediction of all-cause mortality in older adults with HFpEF.Clinical trialsGov identifierNCT05586828.

Project description:BackgroundEmpagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure with preserved ejection fraction, but additional data are needed about its effect on inpatient and outpatient heart failure events.MethodsWe randomly assigned 5988 patients with class II through IV heart failure with an ejection fraction of >40% to double-blind treatment with placebo or empagliflozin (10 mg once daily), in addition to usual therapy, for a median of 26 months. We prospectively collected information on inpatient and outpatient events reflecting worsening heart failure and prespecified their analysis in individual and composite end points.ResultsEmpagliflozin reduced the combined risk of cardiovascular death, hospitalization for heart failure, or an emergency or urgent heart failure visit requiring intravenous treatment (432 versus 546 patients [empagliflozin versus placebo, respectively]; hazard ratio, 0.77 [95% CI, 0.67-0.87]; P<0.0001). This benefit reached statistical significance at 18 days after randomization. Empagliflozin reduced the total number of heart failure hospitalizations that required intensive care (hazard ratio, 0.71 [95% CI, 0.52-0.96]; P=0.028) and the total number of all hospitalizations that required a vasopressor or positive inotropic drug (hazard ratio, 0.73 [95% CI, 0.55-0.97]; P=0.033). Compared with patients in the placebo group, fewer patients in the empagliflozin group reported outpatient intensification of diuretics (482 versus 610; hazard ratio, 0.76 [95% CI, 0.67-0.86]; P<0.0001), and patients assigned to empagliflozin were 20% to 50% more likely to have a better New York Heart Association functional class, with significant effects at 12 weeks that were maintained for at least 2 years. The benefit on total heart failure hospitalizations was similar in patients with an ejection fraction of >40% to <50% and 50% to <60%, but was attenuated at higher ejection fractions.ConclusionsIn patients with heart failure with preserved ejection fraction, empagliflozin produced a meaningful, early, and sustained reduction in the risk and severity of a broad range of inpatient and outpatient worsening heart failure events. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03057977.

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The controlling nutritional status score predicts outcomes of cardiovascular events in patients with heart failure with preserved ejection fraction.

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