A Modification Through Assessment Of Current Situation Of Nutritional Evaluation In Heart Failure Patients And Its Clinical Application

BackgroundMalnutrition is common among heart failure (HF) patients. Recent studies have suggested that Malnutrition as defined using multidimensional nutritional evaluation tools may affect clinical outcomes in heart failure (HF). Nutrition assessment and screening constitute the first of 4 steps of the Nutrition Care Process and are thus very important to have nutritional intervention as soon as possible to improve outcomes for HF patients. Multidimensional nutritional assessment and screening tools have been applied in HF patients. The accuracy of any tool is seriously compromised by many confounding factors, particularly oedema and inflammatory response. Most importantly, no gold standard or scientific consensus regarding the nutritional evaluation of patients with HF has been developed despite the crucial role malnutrition plays in the prognosis of HF.The aim of this study is to Determine the best nutritional assessment and screening tools in heart failure and to improves the accuracy of the nutritional evaluation in heart failure, and can be independent predictors for poor clinical outcome, while maintaining the advantages of simple, fast, low cost, noninvasive.Objectives1. The prevalence of Malnutrition and the risk of Malnutrition in HF.2. We conducted this systematic review to critically appraise the use of multi-dimesional evaluation tools in the prediction of clinical outcomes in HF. And to Determine the superiority of one or more nutritional screening tools to other tools in the context of HF.3. On the based of diseases characteristics, we plan to invented a Mini-nutrition as sessment special for heart failure (MNA-HF) with conventional Mini-nutrition assessment(MNA).Method1. Relevant studies were retrieved from major databases (i.e., PubMed, Embase, Web of Science, and ScienceDirect).We performed descriptive analyses of all identified articles involving qualitative analyses. We used STATA to conduct meta-analyses when at least three studies that tested the same type of nutritional assessment or screening tools and used the same outcome were identified. Sensitivity analyses were conducted to validate our positive results.2. A total of 252 patients were evaluated. In the invented MNA-HF system, the items were entered into the logistic regression model and weighted scores were calculated according to the weighted effect of the MNA items. The efficiencies of MNA and MNA-HF were compared to predict malnutrition according to albumin.Result1. We identified 17 articles with qualitative analyses and 11 with quantitative analy sis after comprehensive literature searching and screening. We determined that the prevalence of malnutrition is high in HF (range:15%-90%), particularly in advanced and acute decompensated HF (approximate range:75%-90%). Malnutrition as identified by multidimensional evaluation tools may be significantly associated with hospitalization, length of stay, and complications and is particularly strongly associated with high mortality. The meta-analysis revealed that compared with other tools, Mini Nutrition Assessment (MNA) scores were the strongest predictors of mortality in HF [HR (4.32,95% CI:2.30-8.11)]. Our results remained reliable after conducting sensitivity analyses. The prevalence of malnutrition is high in HF, particularly in advanced and acute decompensated HF.2. After testing multiple versions, we identified an optimal 15-item MNA-HF total score ranging from 0 to 29.The cut off points of MNA-HF for at risk of malnutrition and malnourished were identified as 16 and 22, respectively. Using an MNA-HF score of 16 as normal, diagnostic accuracy was 87.5% for predicting malnutrition.In predictive analysis, MNA-HF showed a higher prognostic value for the composite endpoint of all-cause death and rehospitalizationand nutritional-related complications (P<0.05)Conclusions1. The prevalence of Malnutrition or the risk of Malnutrition is high in HF pa tients, particularly advanced and acute decompensated HF patients (75%-90%)2. Moreover, undernutri-tion and the risk of Malnutrition as identified by multidi mensional evaluation tools are significantly associated unfavourable prognoses and increased mortality in patients with HF.MNA were particularly predictive, and MNA can be used as a "gold standard" to evaluate the specificities and sensitivities of different tools in fu-ture research with HF patients until a consensus is reached.3. MNA-HF improves the accuracy of the nutritional evaluation in heart failure, and can be independent predictors for poor clinical outcome, while maintaining the advantages of simple, fast, low cost, noninvasive.Malnutrition and the risk of Malnutrition is the independent predictive factor in HF patients. Thus, after determine the nutritional evaluation tool, it is necessary to have nutritional intervention and to Improve clinical outcomes.