Impacto de la malnutrición en la calidad de vida de los pacientes ancianos con insuficiencia cardíaca avanzada / Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study

Objetivos El objetivo de este estudio fue evaluar la prevalencia de malnutrición, las características clínicas asociadas con la misma y el impacto del estado nutricional en la mortalidad, la calidad de vida y las habilidades relacionadas con el autocuidado y las actividades de la vida diaria en pacientes ancianos con insuficiencia cardíaca avanzada. Métodos Entre junio de 2017 y diciembre de 2019 se llevó a cabo un estudio prospectivo multicéntrico de cohortes que incluyó a 260 pacientes ancianos con insuficiencia cardíaca avanzada que vivían en la comunidad. El estudio se llevó a cabo en 22 centros de atención primaria, tres hospitales universitarios, un hospital de agudos y una unidad de rehabilitación geriátrica de la ciudad de Barcelona (España). El estado nutricional se evaluó al inicio del estudio mediante el cuestionario Mini Nutritional Assessment (MNA) Las medidas de resultado informadas por los pacientes incluyeron calidad de vida (EQ-5D-3L), conducta de autocuidado (Escala europea de conducta de autocuidado en insuficiencia cardíaca) e impacto en las actividades de la vida diaria (índice de Barthel). Resultados Utilizando el MNA-SF, se identificó que 126 (48,5%) pacientes estaban en riesgo de malnutrición y 33 (12,7%) pacientes tenían malnutrición confirmada. En comparación con aquellos con un estado nutricional normal, los pacientes con malnutrición confirmada eran significativamente mayores, con un IMC más bajo y con niveles reducidos de hemoglobina. Durante el seguimiento (mediana de 14,9 meses, intervalo intercuartil: 4,9-26,9), 133 (51,2%) de los participantes incluidos murieron. La mortalidad fue significativamente mayor entre los pacientes con malnutrición (p<0,001). Un mayor índice de Barthel y mejores puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrición (odds ratio [OR] 0,97 [intervalo de confianza del 95%: 0,96-0,98] y OR 0,98 [intervalo de confianza del 95%: 0,96-0,99]), respectivamente... (AU)

ObjectivesThe aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure.MethodsA prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced heart failure was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment (MNA) questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel index).ResultsUsing the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to heart failure patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, interquartile range: 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (P<.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition (Odds Ratio [OR] 0.97 [95% confidence interval: 0.96 to 0.98] and OR 0.98 [95% confidence interval: 0.96 to 0.99]), respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk (OR 1.05 [95% confidence interval: 1.02 to 1.09])... (AU)

Impacto de la malnutrición en la calidad de vida de los pacientes ancianos con insuficiencia cardíaca avanzada / Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study

Objetivos El objetivo de este estudio fue evaluar la prevalencia de malnutrición, las características clínicas asociadas con la misma y el impacto del estado nutricional en la mortalidad, la calidad de vida y las habilidades relacionadas con el autocuidado y las actividades de la vida diaria en pacientes ancianos con insuficiencia cardíaca avanzada. Métodos Entre junio de 2017 y diciembre de 2019 se llevó a cabo un estudio prospectivo multicéntrico de cohortes que incluyó a 260 pacientes ancianos con insuficiencia cardíaca avanzada que vivían en la comunidad. El estudio se llevó a cabo en 22 centros de atención primaria, tres hospitales universitarios, un hospital de agudos y una unidad de rehabilitación geriátrica de la ciudad de Barcelona (España). El estado nutricional se evaluó al inicio del estudio mediante el cuestionario Mini Nutritional Assessment (MNA) Las medidas de resultado informadas por los pacientes incluyeron calidad de vida (EQ-5D-3L), conducta de autocuidado (Escala europea de conducta de autocuidado en insuficiencia cardíaca) e impacto en las actividades de la vida diaria (índice de Barthel). Resultados Utilizando el MNA-SF, se identificó que 126 (48,5%) pacientes estaban en riesgo de malnutrición y 33 (12,7%) pacientes tenían malnutrición confirmada. En comparación con aquellos con un estado nutricional normal, los pacientes con malnutrición confirmada eran significativamente mayores, con un IMC más bajo y con niveles reducidos de hemoglobina. Durante el seguimiento (mediana de 14,9 meses, intervalo intercuartil: 4,9-26,9), 133 (51,2%) de los participantes incluidos murieron. La mortalidad fue significativamente mayor entre los pacientes con malnutrición (p<0,001). Un mayor índice de Barthel y mejores puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrición (odds ratio [OR] 0,97 [intervalo de confianza del 95%: 0,96-0,98] y OR 0,98 [intervalo de confianza del 95%: 0,96-0,99]), respectivamente... (AU)

ObjectivesThe aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure.MethodsA prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced heart failure was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment (MNA) questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel index).ResultsUsing the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to heart failure patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, interquartile range: 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (P<.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition (Odds Ratio [OR] 0.97 [95% confidence interval: 0.96 to 0.98] and OR 0.98 [95% confidence interval: 0.96 to 0.99]), respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk (OR 1.05 [95% confidence interval: 1.02 to 1.09])... (AU)

Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study.

OBJECTIVES: The aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure. METHODS: A prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced HF was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel Index). RESULTS: Using the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to HF patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, Interquartile Range; 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (p < 0.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition, [Odds Ratio (OR) 0.97 (95% Confidence interval 0.96; 0.98) and OR 0.98 (95% Confidence interval, 0.96; 0.99)], respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk, OR 1.05 (95% Confidence interval, 1.02; 1.09. Adjusted multivariate logistic model found that malnutrition was significantly associated with poor quality of life, and adverse impacts on daily activities and self-care. CONCLUSIONS: In community-dwelling older patients with advanced HF, malnutrition was associated with worse patient reported outcome measures related to poor quality of life, and adverse impacts on self-care and daily activities. Nutritional status must be systematically addressed by primary care nurses and family doctors to improve survival rates in these patients. It would be helpful the incorporation of expert professionals in nutrition in the primary health care centres.