Insufficient Calorie Intake Worsens QoL and Increases Readmissions in Patients With HF
Quick Takes
- Elderly patients with heart failure (HF) who reported low sodium intake had dietary protein and micronutrient deficiencies.
- Patients who adhered to sodium diet <2,000 mg/day had a caloric intake below estimated metabolic needs.
- Patients who adhered to a low-sodium diet that resulted in caloric intake below metabolic needs also had poor quality of life (QoL), higher readmission rates, and longer rehospitalization days.
Study Questions:
Do patients with HF with insufficient calorie intake to meet metabolic needs have less post-discharge improvement in functional and symptom-related QoL and greater burden of readmission at 12 weeks?
Methods:
A total of 66 patients over the age of 55 years who had been hospitalized for decompensated HF was enrolled in the pilot GOURMET-HF (Geriatric Out of Hospital Randomized Meal Trial in Heart Failure) study from 3 sites. Patients were randomized at hospital discharge to receive prepackaged, home-delivered, low-sodium, nutritionally robust meals for 4 weeks or usual care. The Kansas City Cardiomyopathy Questionnaire Clinical Summary was administered to participants at discharge and at 12 weeks. Baseline nutritional intake was estimated using the Block Food Frequency Questionnaire and the Nutritional Risk Index. Insufficient calorie intake was derived as <90% of metabolic needs. Adjusted linear, logistic, and negative binomial regression were used to evaluate the association among total energy expenditure, micronutrient and protein deficiencies and malnutrition on QoL, readmission risk, and days re-hospitalized over 12 weeks.
Results:
The final sample consisted of 57 individuals (70 ± 8 years of age; 31% female; body mass index 32 ± 8 kg/m2). Median sodium and caloric intake were 2,987 mg/day and 1,602 kcal/day. Of the total number of patients, 11% screened positively as malnourished. All patients who consumed <2,000 mg/day of sodium had insufficient caloric intake and frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients with insufficient caloric intake had lower Kansas City Cardiomyopathy Questionnaire scores (β = -14.6; 95% confidence interval, -27.3 to -1.9), higher readmission (odds ratio 14.5; 95% confidence interval, 2.2 to 94.4), and more days re-hospitalized (incident rate ratio 31.3; 95% confidence interval, 4.3 to 229.3).
Conclusions:
The original GOURMET-HF pilot study was designed to determine if pre-packaged meals that were low in sodium would improve 30-day readmissions. The secondary analysis evaluated the impact of low-sodium diet on the consumption of dietary protein and micronutrient deficiencies and caloric intake that was insufficient to support baseline metabolic needs. As a result, patients who had insufficient caloric intake had low QoL scores and increased burden of readmission over 12 weeks post-discharge. Even though excess dietary sodium intake can contribute to excessive volume, low-sodium diets <2,000 mg/day have been shown to lead to a greater risk of death and re-admission over long-term follow-up. Malnutrition is prevalent in patients with HF, including patients with elevated body mass indices. Nutritional assessments could improve readmission risk stratification and have the potential to identify patients who could benefit from nutritional intervention.
Perspective:
Patient self-care behaviors that focus on sodium restriction has been the hallmark of patient education. Recent data have shown that sodium intake of <2,000 mg/day can increase risk of inadequate caloric intake and micronutrients as well as death and re-hospitalization. There is a need to determine energy needs, appropriate caloric intake, and comprehensive dietary counseling in patients with HF beyond sodium restriction to improve QoL and risk of readmission.
Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Diet
Keywords: Heart Failure, Diet, Sodium-Restricted, Sodium, Nutrition Assessment, Patient Readmission, Patient Discharge, Micronutrients, Quality of Life, Aftercare
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