Verdu-Rotellar J-M, Calero E, Duran J, Navas E, Alonso S, Argemí N, Casademunt M, Furió P, Casajuana E, Vinyoles E, Muñoz M A
Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
Bellvitge University Hospital, Institut Català de la Salut, Barcelona, Spain.
Rev Clin Esp (Barc). 2024 Feb;224(2):105-113. doi: 10.1016/j.rceng.2024.01.005. Epub 2024 Jan 26.
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.
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).
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.
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.
本研究旨在评估老年晚期心力衰竭患者营养不良的患病率、与营养不良相关的临床特征，以及营养状况对死亡率、生活质量、自我护理能力和日常生活活动的影响。
2017年6月至2019年12月期间，进行了一项前瞻性多中心队列研究，纳入260名社区居住的老年晚期心力衰竭患者。该研究在西班牙巴塞罗那市的22个初级医疗保健中心、3所大学医院、1所急症医院和1个老年康复科开展。使用微型营养评定问卷在基线时评估营养状况。患者报告的结局指标包括生活质量（EQ-5D-3L）、自我护理行为（欧洲心力衰竭自我护理行为量表）以及对日常生活活动的影响（Barthel指数）。
使用MNA-SF，126名（48.5%）患者被确定存在营养不良风险，33名（12.7%）患者被确诊为营养不良。与营养状况正常的心力衰竭患者相比，确诊为营养不良的患者年龄显著更大，体重指数更低，血红蛋白水平更低。在随访期间（中位数14.9个月，四分位间距；4.9 - 26.9），纳入的参与者中有133名（51.2%）死亡，被确定为营养不良的患者死亡率显著更高（p < 0.001）。更好的Barthel指数和生活质量评分与营养不良风险呈负相关，分别为比值比（OR）0.97（95%置信区间0.96；0.98）和OR 0.98（95%置信区间，0.96；0.99）。欧洲心力衰竭自我护理行为量表得分越高，意味着自我护理越差，与更高的营养不良风险相关，OR为1.05（95%置信区间，1.02；1.09）。调整后的多变量逻辑回归模型发现，营养不良与生活质量差以及对日常活动和自我护理的不利影响显著相关。
在社区居住的老年晚期心力衰竭患者中，营养不良与患者报告的与生活质量差相关的结局指标以及对自我护理和日常活动的不利影响有关。初级保健护士和家庭医生必须系统地关注营养状况，以提高这些患者的生存率。在初级医疗保健中心纳入营养专家将有所帮助。
