“Screening for malnutrition scores may be an easy way to determine which ACS patients are at high risk of adverse outcomes and has the added benefit of being a very simple calculation, as many of the variables are taken through routine testing in the emergency setting,” stated Sergio Raposeiras Roubín, MD, Ph.D., a medical heart specialist at University Hospital Álvaro Cunqueiro and researcher on the Centro Nacional de Investigaciones Cardiovasculares in Spain. “Malnutrition is also a potentially modifiable risk factor for these patients, as clinicians could start nutritional interventions during hospitalization and continue after discharge by coordinating with rehabilitation centers and programs.”
In this retrospective study, researchers used the Registry of Acute Coronary Syndrome from University Hospital of Vigo to establish 6,023 sufferers with ACS admitted between January 2010 and September 2017. ACS is an umbrella time period for medical situations impacting blood circulation to the heart muscle, together with heart assaults—each non ST-segment Elevation Myocardial Infarction (NSTEMI) and ST-segment Elevation Myocardial Infarction (STEMI)—and unstable angina or chest ache. Patients with incomplete information for admissions or follow-up and sufferers recognized with leukemia or lymphoma have been excluded. The closing examine cohort included 5,062 sufferers who have been 74.5% males, all white race and had a median age of 66.2 years. Among the enrolled sufferers 10.6% had unstable angina, 49% had NSTEMI and 40.4% had STEMI.
Patients have been categorized as underweight, regular weight, obese or overweight, in accordance with physique mass index. All sufferers have been screened for malnutrition utilizing three calculators:
- The Controlling Nutritional Status rating (CONUT)
- The Nutritional Risk Index (NRI)
- The Prognostic Nutritional Index rating (PNI)
Malnutrition ranged from 8.9% with the PNI, 49.8% with the CONUT and 59.5% with the NRI rating, whereas 38.5% (CONUT) and 20% (NRI) had gentle malnutrition, which PNI doesn’t calculate. Moderate to extreme malnutrition was calculated in 11.2% (CONUT), 39.5% (NRI) and eight.9% (PNI) of sufferers. Using any diploma of malnutrition, 8.9% have been categorized as malnourished by all three scores and 28.2% weren’t malnourished by any rating.
Patients with malnutrition, as measured by any of the three scores have been older, extra more likely to be ladies, and extra more likely to have atrial fibrillation, anemia and diminished left ventricular ejection fraction. The highest prevalence of malnutrition was present in sufferers with a physique mass index thought of underweight or regular weight. However, a vital proportion of sufferers thought of obese or overweight have been malnourished.
Over 3.6 years of follow-up, 16.4% of sufferers died and 20.7% had MACE, which incorporates cardiovascular mortality, one other heart assault or stroke. The researchers discovered worsening malnutrition standing was related to elevated threat of poor outcomes whatever the malnutrition rating used. While the CONUT and PNI outperformed the NRI at predicting mortality and MACE, the CONUT had larger success than the PNI for each outcomes.
“Many clinical cardiologists are not aware of the prevalence of malnutrition, leading it to go unrecognized and untreated,” Raposeiras stated. “Our study demonstrates the importance in screening for malnutrition in all patients admitted for ACS regardless of body mass index. By doing so we may be able to improve risk assessment in these patients and subsequent interventions for secondary prevention.”
In an accompanying editorial, Andrew M. Freeman, MD, of National Jewish Health in Denver, stated, “It’s time for the CVD professional to arm itself with the most cost-effective and powerful tool in the battle against CVD: nutrition and lifestyle medicine.”
Study limitations embrace the single-center retrospective nature, in addition to the shortage of comparability of the prognostic worth of dietary screening instruments with extra advanced complete dietary assessments akin to questionnaires or meals diaries.
Journal of the American College of Cardiology (2020). DOI: 10.1016/j.jacc.2020.06.058
American College of Cardiology
Nutritional screening a potential tool for determining heart assault, angina prognosis (2020, August 10)
retrieved 10 August 2020
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