Association between malnutrition risk and the prognosis of geriatric heart failure patients undergoing left ventricular assist device implantation

Background

Evidence regarding the association between malnutrition risk and the prognosis of geriatric heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation is lacking. Our study aims to investigate how malnutrition risk, assessed using the geriatric nutritional risk index (GNRI) values, relates to the outcomes of geriatric HF patients undergoing LVAD, using data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry.

Methods

A retrospective analysis was conducted using data from INTERMACS registry. Patients aged 65 and above who received LVAD implantation between 2008 and 2017 were included. The GNRI was used to stratify patients into three groups: absence of risk (GNRI > 98), mild risk (GNRI 92–98), and moderate to severe risk (GNRI < 92). The primary outcome was long-term survival for up to four years following LVAD implantation.

Results

We included 5429 patients aged 65 and above undergoing LVADs. The malnutrition risk was presented in 75.8% of the patients before implantation, decreasing to 32.4% at 3 months, and 59.5% at 24 months post-implantation. Moderate-to-severe malnutrition risk, both pre-implant and 6 months post-implant, was associated with an increased risk of death (pre-implant: hazard ratio (HR): 1.25 [95% CI: 1.12–1.40], p < 0.001; 6 months: HR: 2.36 [95% CI: 2.01–2.77], p < 0.001). Mortality decreased with increasing pre-implant GNRI up to approximately 100 and 6-month post-implant GNRI up to 104. Patients with malnutrition risk also had an increased risk of infection, poor quality of life (QoL), and reduced functional exercise capacity after the LVAD implantation.

Conclusions

Malnutrition risk was highly prevalent in HF patients aged 65 and above undergoing LVADs implantation. The presence of malnutrition risk was associated with an increased risk of death, infection, poor quality of life, and reduced functional exercise capacity.