Individualized nutritional support in congestive heart failure inpatients at nutritional risk secondary analysis of a randomized clinical trial

Rationale: Patients with congestive heart failure at risk for malnutrition have an increased risk for mortality and morbidity. Still there’s no conclusive recommendation for or against nutritional support. Thus, in this trial we analyzed the effect of an individualized nutritional support on mortality and different secondary outcomes in a heterogeneous inpatient population with congestive heart failure. Further we studied the prognostic implications for the Nutritional risk screening (NRS-2002) for long-term mortality. Methods: This is a secondary analysis focusing on data of 645 inpatients with congestive heart failure of the originally 2028 Swiss medical inpatients participating the EFFORT Trial, an investigator-initiated, non-commercial, prospective and open-label RCT, that demonstrated the benefit of a early individual nutritional support. Univariate and multivariate regression models were calculated for primary and secondary outcomes to examine the risk reduction for patients receiving nutritional therapy. Results: From the 645 patients (mean age 78.9 years, 390 males), 321 were randomized to the intervention group. During the 30-days observation a total of 75 (11,6%) patients died, 48 (7.4%) in the control group and 27 (4.2%) in the intervention group (HR 0.44 (0.26 to 0.75) p=0.002). Mortality showed a stepwise increase consistent with higher NRS scores at short term (30 days) and long-term (180 days) follow-up (HR of 1.53 (0.95 to 2.47, p=0.078); HR of 1.34 (1.10 to 1.63, p=0.003)) Conclusion: This is the first randomized and controlled trial to demonstrate the benefit of a protocol guided early nutritional support on mortality and adverse outcomes in a heterogeneous population of inpatients with heart failure. Our data provides strong evidence that the nutritional risk, however, is modifiable and can be reduced by the provision of adequate nutritional support Disclosure of Interest: None declared