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Malnutrition in Hospitalized Heart Failure Patients with Reduced Ejection Fraction: Potential Association with Allocation of Guideline-Directed Medical Therapies


 Background: Malnutrition is common in patients with heart failure with reduced ejection fraction (HFrEF) and may influence the long-term prognosis and allocation of guideline-directed medical therapy (GDMT).Methods and Results: We reviewed 1,231 consecutive patient-level records from a multicenter Japanese registry of hospitalized HFrEF patients. Nutritional status was assessed using the geriatric nutritional risk index (GNRI). GDMTs were categorized based on the use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists. The composite outcome of all-cause death and HF rehospitalization was assessed. The mean age was 72.0±14.2 years and 42.6% patients were malnourished (GNRI<92). At discharge, 43.6% and 33.4% of patients were receiving two (double therapy) and three (triple therapy) GDMT agents, respectively. Malnourished patients had lower rates of GDMT use. The standardized GNRI score was independently associated with the occurrence of adverse events (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.79–0.98; p=0.020). Regardless of the GNRI score, lower risk of adverse events was observed with triple therapy (HR: 0.44, 95% CI: 0.29–0.66; p<0.001) or double therapy (HR: 0.44, 95% CI: 0.29–0.66; p<0.001).Conclusion: Malnutrition assessed by GNRI score predicts long-term adverse outcomes among hospitalized HFrEF patients. However, its prognosis may be modified with GDMT.