Article Text

Download PDFPDF
38 The association between malnutrition and congestion in patients with chronic heart failure
  1. Shirley Sze1,
  2. Pierpaolo Pellicori2,
  3. Jufen Zhang3,
  4. Andrew Clark1
  1. 1Department of Cardiology, Castle Hill Hospital, Hull York Medical School
  2. 2Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart and Lung Institute, Imperial College, London, UK
  3. 3Faculty of Medical Science, Anglia Ruskin University


Background Mechanisms leading to malnutrition in chronic heart failure (CHF) are not fully understood. CHF is a condition characterised by systemic venous congestion. We hypothesised that malnutrition in CHF is related to right heart dysfunction and congestion which predispose to bowel oedema and malabsorption, thereby leading to malnutrition.

Methods We assessed malnutrition using the geriatric nutritional risk index (GNRI) and studied its association with congestion, assessed either clinically or by echocardiography, in a large cohort of patients referred to a community CHF clinic.

Results Of the 1058 patients enrolled, CHF was confirmed in 952 (69% males, median age 75(interquartile range (IQR):67–81) years, median NTproBNP 1141 (IQR: 465–2562) ng/L). 39% had HF with reduced (HeFREF, LVEF <40%) and 61% had HF with normal (HeFNEF, LVEF 40% and NTproBNP >125 ng/L) left ventricular ejection fraction.

Overall, 14% of patients were malnourished (GNRI 98). Clinical evidence of congestion, increasing right atrial pressure (RAP) and pulmonary artery pressure and right ventricular systolic dysfunction (RVSD) on echocardiography were associated with malnutrition. Addition of congestion variables to a model comprising of age and NTproBNP did not improve discrimination between malnourished and non-malnourished patients.

During a median follow-up of 1683 days (IQR: 1096–2230 days), 461 (44%) patients died. Malnutrition was an independent predictor of mortality. Patients who were malnourished with both RVSD and increased RAP had 6-fold increased risk of mortality compared to non-malnourished patients without RVSD and had normal RAP. (Figure)

Conclusion Malnutrition and congestion are modestly correlated and each is independently associated with increased mortality in patients with CHF.

  • malnutrition
  • congestion
  • echocardiography

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.