Shirley Sze, Pierpaolo Pellicori, Syed Kazmi, Alan Rigby, John G.F. Cleland, Kenneth Wong, Andrew Lawrence Clark

The authors sought to report the prevalence, clinical associations, and prognostic consequences of malnutrition in outpatients with heart failure (HF). Malnutrition may be common in HF and associated with adverse outcomes, but few data exist. We applied the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI) to consecutive patients referred with suspected HF to a clinic serving a local population (n = 550,000). Of 4,021 patients enrolled, HF was confirmed in 3,386 (61% men; median age: 75 years; interquartile range [IQR]: 67 to 81 years, median N-terminal pro-B-type natriuretic peptide [NT-proBNP] 1,103 ng/l [IQR: 415 to 2,631 ng/l]). Left ventricular ejection fraction was <40% in 35% of patients. Using scores for GNRI ≤91, CONUT >4, and PNI ≤38, 6.7%, 10.0%, and 7.5% patients were moderately or severely malnourished, respectively; 57% were at least mildly malnourished by at least 1 score. Worse scores were most strongly related to older age, lower body mass index, worse symptoms and renal function, atrial fibrillation, anemia, and reduced mobility. During a median follow-up of 1,573 days (IQR: 702 to 2,799 days), 1,723 (51%) patients died. For patients moderately or severely malnourished, 1-year mortality was 28% for CONUT, 41% for GNRI, and 36% for PNI, compared with 9% for those with mild malnutrition or normal nutritional status. A model including only age, urea, and logNT-proBNP, predicted 1-year survival (C-statistic: 0.719) and was slightly improved by adding nutritional indices (up to 0.724; p < 0.001) but not body mass index. Malnutrition is common among outpatients with HF and is strongly related to increased mortality.