Verification of the impact of changes in nutritional status after discharge of heart failure on cardiorenal anemia and the prognosis of HFpEF from the PURSUIT-HFpEF registry
Authors: Kitao T 
Published: October 2022

Abstract

Background
Malnutrition has been reported as poor prognostic factor on heart failure with preserved ejection fraction (HFpEF) in past reports.

Aim
The aim of this study is to evaluate the impact of changes in nutritional status from discharge of heart failure to 1 year after discharge on the prognosis of HFpEF and evaluate the effects of changes in nutritional status on cardiorenal anemia.[Object]The subjects were 547 PURSUIT-HFpEF enrolled patients whose Controlling Nutrition Status (CONUT) was evaluated both at discharge and 1 year after discharge.

Method
First, 547 cases were divided into two groups, normo-nutrition (n=130) and malnutrition (n=417) by CONUT at discharge. Next, the normo-nutrition group (n=130) at discharge was divided into normo-nutrition group (G1, n=88) and malnutrition group (G2, n=42) by CONUT at one later. Similarly, the malnutrition group (n=417) at discharge was divided into normo-nutrition group (G3, n=147) and malnutrition group (G4, n=270). Major Adverse Cardiovascular Event (MACE) was defined as composite of all-cause death, heart failure readmission, and cerebrovascular events. Normo-nutrition was defined as CONUT 0 or 1 and CONUT ≥2 as malnutrition. We examined incidence rate of MACE between G1 and G2 and between G3 and G4 and examined changes in hemoglobin (Hb), eGFR, NT-pro BNP, and CRP at discharge and 1 year later in each group.

Result
MACE and all-cause death were significantly higher in G2 with worsened nutrition than in G1 with maintained normo-nutrition (MACE; G1: 26.1%, G2: 54.8%, p=0.0018, All-cause death; G1: 3.4%, G2: 26.2%, p&lt;0.001). MACE, all-cause death and heart failure readmission were significantly higher in G4 with maintained malnutrition than in G3 with improved nutrition (MACE; G3: 25.9%, G4: 50.7%, p&lt;0.001, all-cause death; G3:8.2%, G4:22.2%, p&lt;0.001, heart failure readmission; G3:19.7%, G4:37.8%, p&lt;0.001). In G2, Hb significantly decreased (12.7±1.8g/dl → 11.6±1.8 g/dl, p&lt;0.001)and CRP tended to increase (0.26±0.41 mg/dl → 1.21±2.99 mg/dl, p=0.0543) 1 year later. Although eGFR did not change significantly, NT-pro BNP increased significantly (1144±1577 pg/ml → 2094±1948 pg/ml, p=0.0140). In G3, Hb significantly increased (11.5±1.9 g/dl → 12.4±1.6g/dl, p&lt;0.001) and CRP significantly decreased (0.84±1.56 mg/dl → 0.22±0.33 mg/dl, p&lt;0.001) 1 year later. Although eGFR significantly decreased (47±19 → 43±17, p&lt;0.001), NT-pro BNP was almost unchanged. In multivariate analysis of data at discharge, Hb were independent predictor of worsening of nutritional status after 1 year (the adjusted hazard ratio 1.33, 95% confidential interval 1.15–1.56, p&lt;0.001).

Conclusion
Post-discharge nutritional management might be important to prevent worsening of the prognosis of HFpEF and change of nutritional status was accompanied by that of anemia and inflammation. The worsening of nutritional status after discharge might be associated with anemia at discharge.

Funding Acknowledgement
Type of funding sources: None.