Key result
Malnutrition (lower geriatric nutritional risk index) independently predicted all-cause death or readmission in elderly HF patients with untreated functional MR.
Why the study?
Patients hospitalized with ADHF often have aggravating MR and receive conservative therapy instead of surgery, but factors affecting their 6-month outcomes were not well investigated.
Cohort (n=146)
No
Malnutrition and underweight are significant independent predictors of adverse outcomes in elderly patients with heart failure and surgically untreated moderate-to-severe functional mitral regurgitation.
Answers are grounded in this paper and cite their sources.
Malnutrition and frailty predict adverse 6-month outcomes in elderly HF with untreated functional MR; leaves open whether targeted interventions alter prognosis.
Background: Hospitalized patients with acute decompensated heart failure (ADHF) frequently exhibit aggravating mitral regurgitation (MR). Those patients do not always undergo surgical mitral valve repair, but particularly in the elderly, they are often treated by conservative medical therapy. This study was aimed to investigate factors affecting 6-month outcomes in hospitalized patients with heart failure (HF) harboring surgically untreated MR. Methods: We screened the presence of MR in hospitalized patients with HF between September 2017 and May 2020 in the Yamaguchi Prefectural Grand Medical (YPGM) center. At the time of discharge of these patients, individuals with surgically unoperated MR, including primary and secondary origin, were consequently recruited to this single-center prospective cohort study. The patients with severe MR who undergo surgical mitral valve treatment were not included in this study. The primary endpoint was all-cause readmission or all-cause death and the secondary endpoint was HF-related endpoint at 6 months after discharge. The Cox proportional hazard regression analyses were employed to assess the predictors for the composite endpoint. Results: Overall, 489 patients with ADHF were admitted to the YPGM center. Of those, 146 patients (30% of total patients with HF) (median age 83.5 years, 69 men) were identified as harboring grade II MR or greater. Consequently, all the recruited patients were diagnosed as functional MR. During a median follow-up of 186.0 days, a total of 55 patients (38%) reached the primary or secondary endpoints (HF death and readmission in 31 patients, other in 24 patients). As a result of multivariate analysis, geriatric nutritional risk index [hazard ratio (HR) = 0.932; 95% CI = 0.887–0.979, p = 0.005], age (HR = 1.058; 95% CI = 1.006–1.112, p = 0.027), and left ventricular ejection fraction (HR = 0.971; 95% CI = 0.945–0.997, p = 0.030) were independent predictors of all-cause death or all-cause admission. Body mass index (HR = 0.793; 95% CI = 0.614–0.890, p = 0.001) and ischemic heart disease etiology (HR = 2.732; 95% CI = 1.056–7.067, p = 0.038) were also independent predictors of the HF-related endpoints. Conclusion: Malnutrition and underweight were substantial predictors of adverse outcomes in elderly patients with HF harboring surgically untreated moderate-to-severe functional MR.
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Miura et al. (2021) conducted a cohort in Heart failure with surgically untreated functional mitral regurgitation (n=146). Geriatric nutritional risk index was evaluated on all-cause readmission or all-cause death (HR 0.932, 95% CI 0.887-0.979, p=0.005). Malnutrition (lower geriatric nutritional risk index) independently predicted all-cause death or readmission in elderly HF patients with untreated functional MR.
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