Individualized Nutritional Support Improves Cardiac Function and Nutritional Status of Elderly Heart Failure Patients

Background    The quality of life of the patient is diminished by chronic heart failure (CHF), which also costs the healthcare system. This study examined the benefits of individualized nutritional support provided by a specialized nursing team on the nutritional status and cardiac function of elderly patients with CHF.
Material and methods    This study included 102 elderly, hospitalized CHF patients. The patients were randomly assigned to two groups of 51 each. During the study protocol, the control group received regular nursing care, while the experimental group received individualized nutritional support by a specialized nursing team. Nutritional-related and cardiac function indicators, inflammatory factors, and life quality scores measured before and after the protocol were compared.
Results    There was a significant increase in total albumin, hemoglobin, and protein in both groups during the protocol, but the final concentrations were significantly higher in the experimental group (p<0.05). In both groups, the left ventricular ejection fraction was increased after the protocol, while the left ventricular end-systolic dimension and the left ventricular end-diastolic dimension significantly decreased. The improvements in these variables were greater in the experimental group (p<0.05). The experimental group also exhibited significantly reduced tumor necrosis factor-α, interleukin-6, and high sensitivity C-reactive protein (p<0.05), and the experimental group reported higher quality of life (p<0.05) and nursing satisfaction (p<0.05).
Conclusion    Nutritional support of elderly CHF patients administered by a specialized nursing team improved nutrition, cardiac function, inflammatory status, and quality of life compared to standard nutrition and regular nursing care.

1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021;42(36):3599–726. DOI: 10.1093/eurheartj/ehab368

2. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e876–94. DOI: 10.1161/CIR.0000000000001062

3. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. European Journal of Heart Failure. 2022;24(1):4–131. DOI: 10.1002/ejhf.2333

4. Arrigo M, Jessup M, Mullens W, Reza N, Shah AM, Sliwa K et al. Acute heart failure. Nature Reviews Disease Primers. 2020;6(1):16. DOI: 10.1038/s41572-020-0151-7

5. Pontremoli R, Borghi C, Perrone Filardi P. Renal protection in chronic heart failure: focus on sacubitril/valsartan. European Heart Journal - Cardiovascular Pharmacotherapy. 2021;7(5):445–52. DOI: 10.1093/ehjcvp/pvab030

6. Alvarez P, Sianis A, Brown J, Ali A, Briasoulis A. Chronic disease management in heart failure: focus on telemedicine and remote monitoring. Reviews in Cardiovascular Medicine. 2021;22(2):403–13. DOI: 10.31083/j.rcm2202046

7. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology. 2022;79(17):e263–421. DOI: 10.1016/j.jacc.2021.12.012

8. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary. Journal of the American College of Cardiology. 2022;79(17):1757–80. DOI: 10.1016/j. jacc.2021.12.011

9. Haynes R, Zhu D, Judge PK, Herrington WG, Kalra PA, Baigent C. Chronic kidney disease, heart failure and neprilysin inhibition. Nephrology Dialysis Transplantation. 2020;35(4):558–64. DOI: 10.1093/ndt/gfz058

10. Bredy C, Ministeri M, Kempny A, Alonso-Gonzalez R, Swan L, Uebing A et al. New York Heart Association (NYHA) classification in adults with congenital heart disease: relation to objective measures of exercise and outcome. European Heart Journal - Quality of Care and Clinical Outcomes. 2018;4(1):51–8. DOI: 10.1093/ehjqcco/qcx031

11. Chinese Medical Association. Guideline for primary care of chronic heart failure (2019). Chinese Journal of General Practitioners. 2019;18(10):936–47. DOI: 10.3760/cma.j.is sn.1671-7368.2019.10.008

12. Alikiaii B, Heidari Z, Fazeli A, Rahimi Varposhti M, Moradi Farsani D, Fattahpour S et al. Evaluation of the effectiveness of the Nutritional Risk Screening System 2002 (NRS‐2002) in COVID‐19 patients admitted to the intensive care unit. International Journal of Clinical Practice. 2021;75(12):e14934. DOI: 10.1111/ijcp.14934

13. Sysal P, Veronese N, Arik F, Kalan U, Smith L, Isik AT. Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults. Clinical Interventions in Aging. 2019;14:693–9. DOI: 10.2147/CIA.S196770

14. Ndahimana D, Kim E-K. Energy Requirements in Critically Ill Patients. Clinical Nutrition Research. 2018;7(2):81–90. DOI: 10.7762/cnr.2018.7.2.81

15. Philips. EPIQ 7 Ultrasound System User Manual. © 2013 Koninklijke Philips. All rights reserved. Published in USA. Av. at: https://usme.com/wp-content/uploads/2022/06/epiq_7.pdf.

16. Garin O, Herdman M, Vilagut G, Ferrer M, Ribera A, Rajmil L et al. Assessing health-related quality of life in patients with heart failure: a systematic, standardized comparison of available measures. Heart Failure Reviews. 2014;19(3):359–67. DOI: 10.1007/s10741-013-9394-7

17. Hersberger L, Dietz A, Bürgler H, Bargetzi A, Bargetzi L, Kägi-Braun N et al. Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure. Journal of the American College of Cardiology. 2021;77(18):2307–19. DOI: 10.1016/j.jacc.2021.03.232

18. Fernández-Pombo A, Rodríguez-Carnero G, Castro AI, Cantón-Blanco A, Seoane LM, Casanueva FF et al. Relevance of nutritional assessment and treatment to counteract cardiac cachexia and sarcopenia in chronic heart failure. Clinical Nutrition. 2021;40(9):5141–55. DOI: 10.1016/j.clnu.2021.07.027

19. Schuetz P, Sulo S, Walzer S, Krenberger S, Stagna Z, Gomes F et al. Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure. Nutrients. 2022;14(9):1703. DOI: 10.3390/nu14091703

20. Yasuhara S, Maekawa M, Bamba S, Kurihara M, Nakanishi N, Yamamoto T et al. Energy Metabolism and Nutritional Status in Hospitalized Patients with Chronic Heart Failure. Annals of Nutrition and Metabolism. 2020;76(2):129–39. DOI: 10.1159/000507355

21. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Revista Española de Cardiología (English Edition). 2022;75(6):523. DOI: 10.1016/j.rec.2022.05.005

22. Bozkurt B, Fonarow GC, Goldberg LR, Guglin M, Josephson RA, Forman DE et al. Cardiac Rehabilitation for Patients With Heart Failure. Journal of the American College of Cardiology. 2021;77(11):1454–69. DOI: 10.1016/j.jacc.2021.01.030

23. Uysal H, Öz Alkan H, Enç N, Yiğit Z. Assessment of Dietary Habits in Patients With Chronic Heart Failure. Journal of Nursing Research. 2020;28(1):e65. DOI: 10.1097/jnr.0000000000000329

24. Matsumura K, Teranaka W, Taniichi M, Otagaki M, Takahashi H, Fujii K et al. Differential effect of malnutrition between patients hospitalized with new‐onset heart failure and worsening of chronic heart failure. ESC Heart Failure. 2021;8(3):1819–26. DOI: 10.1002/ehf2.13279

25. McGrath R, Lee D-C, Kraemer WJ, Vincent BM, Shaughnessy KA, Terbizan DJ. Weakness is Associated with Time to Incident Chronic Heart Failure in Aging Americans. The Journal of nutrition, health and aging. 2020;24(1):16–9. DOI: 10.1007/s12603-019-1266-y

26. Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart. 2022;108(17):1351–60. DOI: 10.1136/heartjnl-2021-320131

27. Rusli C, Bukhari A, A. Taslim N, As’Ad S, Rasyid H. Nutrition Therapy in Critically Ill Overweight Elderly Patient with Heart Failure, Myocardial Infarction, Pneumonia, and Chronic Kidney Disease. Journal of Nutritional Science and Vitaminology. 2020;66(Suppl):S25–31. DOI: 10.3177/jnsv.66.S25

28. Manceau H, Ausseil J, Masson D, Feugeas J-P, Sablonniere B, Guieu R et al. Neglected Comorbidity of Chronic Heart Failure: Iron Deficiency. Nutrients. 2022;14(15):3214. DOI: 10.3390/nu14153214

29. Hotta K, Taniguchi R, Nakayama H, Yamaguchi F, Sato Y. The Effects of an Oral Nutritional Supplement with Whey Peptides and Branched-Chain Amino Acids for Cardiac Rehabilitation of Patients with Chronic Heart Failure: A Randomized, Pilot Study. International Heart Journal. 2021;62(6):1342–7. DOI: 10.1536/ihj.21-102

30. Guerra-Sánchez L, Fresno-Flores M, Martínez-Rincón C. Effect of a double nutritional intervention on the nutritional status, functional capacity, and quality of life of patients with chronic heart failure: 12-month results from a randomized clinical trial. Nutrición Hospitalaria. 2020;34(3):422–31. DOI: 10.20960/nh.02820

31. Lisco G, Giagulli VA, Iovino M, Zupo R, Guastamacchia E, De Pergola G et al. Endocrine system dysfunction and chronic heart failure: a clinical perspective. Endocrine. 2022;75(2):360–76. DOI: 10.1007/s12020-021-02912-w