Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in Emergency Departments
Francisco Javier Martín-Sánchez 1 , Federico Cuesta Triana 2 , Xavier Rossello 3 , Rebeca Pardo García 4 , Guillermo Llopis García 5 , Francisca Caimari 6 , María Teresa Vidán 7 , Pedro Ruiz Artacho 8 , Juan González Del Castillo 9 , Pere Llorens 10 , Pablo Herrero 11 , Javier Jacob 12 , Víctor Gil 13 , Cristina Fernández Pérez 14 , Pedro Gil 2 , Héctor Bueno 15 , Òscar Miró 13 , Pilar Matía Martín 16 , Representing the members of the OAK Register Investigators; Esther Rodríguez Adrada 17 , María Carmen Santos 17 , Lucía Salgado 17 , Berenice Nayla Brizzi 17 , María Luisa Docavo 17 , María Del Mar Suárez-Cadenas 17 , Carolina Xipell 18 , Carolina Sánchez 18 , Sira Aguiló 18 , Josep María Gaytan 18 , Alba Jerez 18 , María José Pérez-Durá 19 , Pablo Berrocal Gil 19 , María Luisa López-Grima 20 , Amparo Valero 20 , Alfons Aguirre 21 , Maria Àngels Pedragosa 21 , Pascual Piñera 22 , Paula LázaroAragues 22 , José Andrés Sánchez Nicolás 22 , Miguel Alberto Rizzi 23 , Sergio Herrera Mateo 23 , Aitor Alquezar 23 , Alex Roset 24 , Carles Ferrer 24 , Ferrán Llopis 24 , José María Álvarez Pérez 25 , María Pilar López Diez 25 , Fernando Richard 25 , José María Fernández-Cañadas 26 , José Manuel Carratalá 26 , Patricia Javaloyes 26 , Juan Antonio Andueza 27 , José Antonio Sevillano Fernández 27 , Rodolfo Romero 28 , Marta Merlo Loranca 28 , Virginia Álvarez Rodríguez 28 , María Teresa Lorca 29 , Luis Calderón 29 , Ester Soy Ferrer 30 , José Manuel Garrido 31 , Enrique Martín Mojarro 32
Background: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF.
Material and methods: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality.
Results: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status.
Conclusions: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.
CITATION Eur J Intern Med. 2019 Jul;65:69-77. doi: 10.1016/j.ejim.2019.04.014. Epub 2019 May 7.