Background and Aims Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status. We undertook this study to assess whether a ...nutritional intervention in malnourished hospitalized patients with heart failure benefits morbidity and mortality. Methods A multicenter, randomized, controlled clinical trial was conducted. A total of 120 malnourished hospitalized patients due to acute heart failure were randomised to conventional heart failure treatment or conventional heart failure treatment combined with an individualized nutritional intervention. The primary endpoint of this study was a composite of all-cause death or readmission for worsening of HF, with a maximum follow-up of 12 months. Analysis was by intention to treat. Results Recruitment was stopped early according to the study protocol after completing the follow-up of the first 120 patients enrolled (59 in the intervention group and 61 in the control group). Both groups were homogeneous in baseline characteristics. At 12 months, the primary outcome occurred in 27.1% of patients in the intervention group and in 60.7% of patients in the control group (hazard ratio 0.45; 95% confidence interval CI, 0.19–0.62, p = 0.0004). In total, 20.3% of patients died in the intervention group and 47.5% in the control group (hazard ratio 0.37, 95% CI, 0.19–0.72, p = 0.003). Readmission due to heart failure was also lower in the intervention group (10.2 vs. 36.1%, p = 0.001). Conclusion Nutritional intervention in malnourished hospitalized patients with heart failure reduces the risk of death from any cause and the risk of readmission for worsening of heart failure ( ClinicalTrial.gov NCT01472237 ).
Hypoalbuminemia is common in acute heart failure (HF) patients and has been associated with increased hospital mortality and long-term mortality. Undernutrition is a factor causing hypoalbuminemia. ...The PICNIC study results show that a nutritional intervention in undernourished acute HF patients reduces the risks of all-cause death and of readmission for HF. We aimed to investigate whether the efficacy of a nutritional intervention is consistent among the subgroups of patients with and without hypoalbuminemia.
In PICNIC study, a total of 120 malnourished hospitalized patients due to acute HF were randomized to conventional HF treatment or conventional HF treatment combined with an individualized nutritional intervention. The primary endpoint was a composite of all-cause death or readmission for worsening of HF, with a maximum follow-up of 12 months. In this post-hoc sub-analysis we assessed the interaction of the effects of a nutritional intervention among patients with and without hypoalbuminemia. Analysis was by intention to treat.
59 (49,2%) patients demonstrated hypoalbuminemia and 61 (50,8%) had normalbuminemia. At 12 months, the number of events for the primary endpoint in the intervention group compared with the control group was consistent among patients with hypoalbuminemia (28.6% intervention vs 61.3% control, HR 0,35, 95% CI 0,15–0,81) and those without (25.8% intervention vs 60% control, HR 0,35, 95% CI 0,15–0,79; interaction p = 0,86).
There was no evidence that the relative efficacy of a nutritional intervention in undernourished acute HF patients was different between patients with normalbuminemia and those with hypoalbuminemia.
The prevalence of malnutrition among patients with heart failure and the role it might play in prognosis is not currently known. The aim of this study was to analyse the prevalence and risk of ...malnutrition as well as its possible influence on long-term mortality in patients with heart failure.
A prospective analysis was conducted on 208 patients discharged consecutively from our centre between January 2007 and March 2008 after being hospitalised with heart failure. Before discharge, a complete nutritional assessment was performed and diagnosis of malnutrition and risk of malnutrition was done with the Mini Nutritional Assessment. Its possible independent association with mortality was assessed by a Cox multivariate analysis.
The mean age of the patients was 73 ± 10 years, with 46% women; the most common aetiology of heart failure was ischaemia (41%). In addition, 13% were classified as malnourished, 59.5% at risk of malnutrition and 27.5% were well-nourished. At a median follow-up of 25 months, mortality in the three groups was 76%, 35.9% and 18.9%, respectively (log-rank, P<.001). In the Cox multivariate analysis, the malnutrition state was an independent predictor of mortality (hazard ratio 3.75, 95% confidence interval, 1.75-8.02, P=.001).
Malnutrition and the risk of malnutrition are highly prevalent in patients hospitalised for heart failure. Furthermore, we found that the state of malnutrition as defined by the Mini Nutritional Assessment survey is an independent predictor of mortality in these patients.
Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status. It is unknown whether a nutritional intervention can modify the ...prognosis of these patients. The aim of this study is to assess the efficacy of a nutritional intervention on morbidity and mortality in hospitalized patients with heart failure who are malnourished.
PICNIC is a multicentre, randomized, controlled trial in which hospitalized patients with heart failure and malnutrition, as defined by the Mini Nutritional Assessment, are randomly assigned to conventional management of heart failure or conventional management of heart failure and an individualized nutritional intervention consisting of 3 points: optimization of diet, specific recommendations, and prescription, if deemed necessary, of nutritional supplements. A sample size of 182 patients for a maximum follow-up of 12 months has been estimated. The primary endpoint is time to death from any cause or rehospitalization because of heart failure. Analysis is by intention to treat.
PICNIC study will determine the prognostic impact of a nutritional intervention in hospitalized patients with heart failure who are malnourished.
Los pacientes hospitalizados por insuficiencia cardiaca en estado de desnutrición tienen un pronóstico más desfavorable que los que están en adecuado estado nutricional. Se desconoce si una intervención nutricional puede modificar el pronóstico de estos pacientes. El objetivo de este estudio es evaluar si una intervención nutricional sobre pacientes hospitalizados con insuficiencia cardiaca desnutridos produce beneficio en su morbimortalidad.
PICNIC es un ensayo clínico multicéntrico, aleatorizado y controlado, en el que se asigna aleatoriamente a los pacientes hospitalizados por insuficiencia cardiaca aguda que además estén en estado de desnutrición, definido según la puntuación de la encuesta Mini Nutritional Assessment, a tratamiento convencional de la insuficiencia cardiaca o a tratamiento convencional de la insuficiencia cardiaca más una intervención nutricional individualizada que consta de tres puntos: optimización de la dieta, recomendaciones específicas y prescripción, si se estima necesario, de suplementos nutricionales. Se ha estimado un tamaño muestral de 182 pacientes para un periodo máximo se seguimiento de 12 meses. La variable principal del estudio será el tiempo hasta la muerte por cualquier causa o reingreso por insuficiencia cardiaca. El análisis se realiza por intención de tratar.
El estudio PICNIC determinará el impacto pronóstico de una intervención nutricional en pacientes hospitalizados con insuficiencia cardiaca desnutridos.
A 28‐year‐old woman was referred to closure of a residual shunt produced through a percutaneous device previously implanted in the atrial septum. The imaging protocol to guide the procedure included ...2D TEE and real time 3D (RT3D) transesophageal echocardiography (TEE) imaging. RT3D TEE facilitated the evaluation of the defect morphology, and the relationship with the previous device, allowing a proper understanding of the mechanism responsible for the residual shunt. It was also a useful tool for guiding device deployment, providing clear intraprocedural information about catheter position and the spatial relationship with the previous device. In conclusion, RT3D TEE and 2D TEE are complementary techniques for the evaluation and guidance of transcatheter closure of complex atrial septal defects. (Echocardiography 2011;28:E64‐E67)
A 28‐year‐old woman was referred to closure of a residual shunt produced through a percutaneous device previously implanted in the atrial septum. Real time 3D (RT3D) transesophageal echocardiography (TEE) facilitated the evaluation of the defect morphology, and the relationship with the previous device, allowing a proper understanding of the mechanism responsible for the residual shunt. It was a useful tool for guiding device deployment, providing intraprocedural information about catheter position and the spatial relationship with the previous device. In conclusion, RT3D TEE and 2D TEE are complementary techniques for the evaluation and guidance of transcatheter closure of complex atrial septal defects.
Malnutrition and Heart Failure: Comments Bonilla-Palomas, Juan L.; Gámez-López, Antonio L.; Anguita-Sánchez, Manuel P. ...
Revista española de cardiología (English ed.),
02/2012, Volume:
65, Issue:
2
Journal Article
PDF
