Nutritional characteristics and the potential impact of dietetic intervention on patients assessed for heart transplant.

BACKGROUND & AIMS: Heart transplant (HT) is the gold standard treatment for people with end stage heart failure (HF). Up to 46 % of patients with chronic HF are malnourished and increasing rates of obesity have also been identified. Therefore, at time of HT assessment, patients are required to meet eligibility criteria, including nutrition targets. It is recommended that patients being considered for HT receive comprehensive assessment by a multidisciplinary team (MDT) to assist in meeting HT criteria. This study aimed to describe the baseline nutritional characteristics of patients undergoing HT assessment and to explore the impact of dietetic intervention on key nutritional parameters including BMI and malnutrition status pre-transplant.

METHODS

This study was a single-centre combined retrospective and prospective observational cohort study. Adults who underwent HT assessment and met inclusion criteria between January 1, 2015 and June 30, 2021 were included. Key nutrition-related parameters assessed were weight, Body Mass Index (BMI), and nutritional status using the Subjective Global Assessment (SGA): A well-nourished, B and C moderately and severely malnourished, collected at HT assessment, listing and HT. The impact of dietetic intervention on nutrition-related parameters was also assessed.

RESULTS

255 patients were included, with 2.7 % (n = 7) underweight, 32.2 % healthy weight, 38.8 % overweight and 26.3 % obese. Of 161 patients assessed using the SGA 22.4 % (n = 36) were moderately or severely malnourished. 26 patients had a relative nutrition contraindication for HT listing (BMI>35 kg/m and/or HbA1c >7.5 %) and n = 39 had suboptimal nutritional status including BMI <18.5 kg/m and/or presence of malnutrition.Dietetic intervention did not result in statistically significant changes in weight, BMI or nutritional status. 25.5 % of patients had relative nutritional contraindications to HT or suboptimal nutritional parameters and 9 had a decline in nutritional status, defined as developing malnutrition or worsened malnutrition.

CONCLUSIONS

This study showed a quarter of HT patients had suboptimal nutrition-related parameters including malnutrition, underweight, overweight or obesity at time of HT assessment, indicating opportunity for improved nutrition support prior to HT. The results also indicated that nutritional status can deteriorate in patients waiting for HT. Routine nutrition assessment and regular monitoring by a dietitian has the potential to support patients in their HT journey through optimising BMI and preventing nutritional decline.