Energy Intake During Hospital Stay to Improve Identification of Elderly Patients With Heart Failure at High-Risk

physician attending female senior patient in hospital room
Energy intake during hospital stay was found to be an independent predictor of mortality among elderly patients with heart failure.

Energy intake during hospital stay was found to be an independent predictor of mortality among elderly patients with heart failure, according to a study published in Clinical Research in Cardiology.

The data of 419 patients (aged ≥65 years; median age, 78 years; 49% women) with heart failure were retrospectively assessed. In this cohort, the median body mass index (BMI) was 21.1 kg/m2, and 59%, 31%, and 5% of the participants were in New York Heart Association functional class II, III, and IV, respectively at discharge. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess nutritional status, and daily energy intake was calculated from intake during the 3 days preceding hospital discharge.

The median MNA-SF score in this cohort was 7 points (interquartile range [IQR], 6-9 points), and 52% and 40% of the patients were classified as being in a state of malnutrition and at risk for malnutrition, respectively.

A total of 110 patients (26%) died at a median of 1.52 years (IQR, 0.96-2.94 years). Patients in the low vs high or middle tertile of daily energy intake were found to have a higher mortality rate, according to Kaplan–Meier survival curves. In addition, low daily energy intake was independently associated with higher mortality in multivariate Cox regression analyses adjusted for factors such as age, sex, brain natriuretic peptide (BNP) level, Charlson Comorbidity Index score, history of heart failure hospitalization, and cachexia, in addition to the MNA-SF score.

 The accuracy of post-discharge mortality prediction was improved when MNA-SF score and energy intake were added to the adjustment model (continuous net reclassification improvement, 0.355, P =.003; integrated discrimination improvement, 0.029; P =.003). The risk for all-cause mortality was lowest among patients with heart failure who consumed 31.5 kcal/kg/day of energy, according to a fully adjusted dose-dependent association analysis.

“There are 2 salient findings in the present study,” stated the researchers. “First, we found that daily energy intake during hospitalization was an independent predictor of all-cause mortality after discharge in [patients with] heart failure after adjustment for nutritional status and known prognostic markers including BNP and cachexia. Second, addition of daily energy intake to established predictors of the prognosis of heart failure improves risk stratification of elderly patients with heart failure.”

Study limitations include its retrospective, single-center, and observational design and small cohort. In addition, ambulatory patients and patients who died in the hospital were not included.

“Addition of daily energy intake to MNA-SF score improved the predictive ability of MNA-SF alone, and low daily energy intake could detect higher risk patients even in a subgroup of [patients with] heart failure [and] malnutrition,” concluded the study authors. “These findings suggest that assessment of energy intake is important in risk stratification for mortality of elderly [patients with] heart failure, especially those with malnutrition and in planning comprehensive therapy for heart failure.”


Katano S, Yano T, Kouzu H, et al. Energy intake during hospital stay predicts all-cause mortality after discharge independently of nutritional status in elderly heart failure patients [published online January 5, 2021]. Clin Res Cardiol. doi: 10.1007/s00392-020-01774-y