Nutritional intervention in malnourished hospitalized patients with heart failure
Abstract
Background and aims Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status. We undertook this study to assess whether a nutritional intervention in malnourished hospitalized patients with heart failure benefits morbidity and mortality. Methods A multicenter, randomized, controlled clinical trial was conducted. A total of 120 malnourished hospitalized patients due to acute heart failure were randomised to conventional heart failure treatment or conventional heart failure treatment combined with an individualized nutritional intervention. The primary endpoint of this study was a composite of all-cause death or readmission for worsening of HF, with a maximum follow-up of 12 months. Analysis was by intention to treat. Results Recruitment was stopped early according to the study protocol after completing the follow-up of the first 120 patients enrolled (59 in the intervention group and 61 in the control group). Both groups were homogeneous in baseline characteristics. At 12 months, the primary outcome occurred in 27.1% of patients in the intervention group and in 60.7% of patients in the control group (hazard ratio 0.45; 95% confidence interval [CI], 0.19-0.62, p = 0.0004). In total, 20.3% of patients died in the intervention group and 47.5% in the control group (hazard ratio 0.37, 95% CI, 0.19-0.72, p = 0.003). Readmission due to heart failure was also lower in the intervention group (10.2 vs. 36.1%, p = 0.001). Conclusion Nutritional intervention in malnourished hospitalized patients with heart failure reduces the risk of death from any cause and the risk of readmission for worsening of heart failure (ClinicalTrial.govNCT01472237).
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In a clinical trial of inpatients with heart failure and malnutrition, an individualized nutritional approach improved mortality and readmissions.
“In a clinical trial of inpatients with HF (12.5% receiving inotropes) and malnutrition,132 an individualized nutritional approach improved mortality and readmissions.”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [132]
In the PICNIC study, individualized registered dietitian nutritionist-led dietary counseling and support reduced the composite of hospital readmissions and mortality, reduced mortality as a secondary end point, and improved quality of life in patients with heart failure and risk of malnutrition.
“Individualized RDN-led dietary counseling and support reduced the composite of hospital readmissions and mortality, as well as mortality as a secondary end point, and improved quality of life.132”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [132]
In the PICNIC study, both mortality (HR 0.37, 95% CI 0.19-0.72, p=0.003) and readmission rates were lower in the intervention group (10.2 vs 36.1%, p=0.001).
“Both mortality (HR 0.37, 95% CI 0.19e0.72,p ¼ 0.003) and readmission rates were lower in the IG patients (10.2 vs. 36.1%,p ¼ 0.001)”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [126]
In the PICNIC study, at twelve months the primary composite endpoint (all-cause mortality and readmission due to deterioration of heart failure) occurred in 27.1% of the intervention group compared to 60.7% of control patients (HR 0.45, 95% CI 0.19-0.62, p=0.0004).
“At twelve months, the primary composite endpoint (all-cause mortality and readmission due to deterioration of heart failure) occurred in 27.1% of the IG compared to 60.7% of CG patients (HR 0.45, 95% CI 0.19e0.62,p ¼ 0.0004).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [126]
Readmission rates were significantly reduced after six months of nutritional intervention in several trials but not all.
“it was significantly reduced after six months of nutritional intervention in several trials (level of evidence: 1-) [116] (level of evidence: 1þ) [130] (level of evidence: 1þþ) [126] but not all (level of evidence: 1þ) [125].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [126]
Patients with chronic heart failure have shown strong benefit from nutritional support, including a survival benefit.
“Similar results were also found within the NOURISH study with a significant survival benefit associated with nutritional support [9] (Level of evidence: 1þþ).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [126]
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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
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Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001063 · Cited by 4,922 · see citing works
Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure
Hersberger, L., Dietz, A., Bürgler, H., Bargetzi, A., Bargetzi, L., Kägi-Braun, N., Tribolet, P., Gomes, F., Hoess, C., Pavlicek, V., et al. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.03.232 · Cited by 168 · see citing works
The role of diet and nutrition in heart failure: A state-of-the-art narrative review
Billingsley, H. E., Hummel, S. L., & Carbone, S. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.08.004 · Cited by 106 · see citing works
ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“…þ ) [131 ] or in older patients ( level of evidence: 1) [132], it was signi fi cantly reduced after six months of nutritional intervention in several trials ( level of evidence: 1) [116] ( level of evidence: 1 þ ) [130] ( level of evidence: 1 þþ ) [126] but not all ( level of evidence: 1 þ ) [125].”
InfluentialDiagnosis and management of malnutrition in patients with heart failure
Esteban-Fernández, A., Villar-Taibo, R., Alejo, M., Arroyo, D., Bonilla Palomas, J. L., Cachero, M., Joaquin, C., Méndez Bailón, M., Pérez-Rivera, J. Á., Romero-Vigara, J. C., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093320 · Cited by 61 · see citing works
Self-citationTonet, E., Campana, R., Caglioni, S., Gibiino, F., Fiorio, A., Chiaranda, G., Zagnoni, S., Casella, G., & Campo, G. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10071508 · Cited by 26 · see citing works
Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
Pattern of inpatient pediatric cardiology consultations in sub-Saharan Africa
Puri, K., Kazembe, P., Mkaliainga, T., Chiume, M., Cabrera, A. G., & Sims Sanyahumbi, A. (2018) · Congenital Heart Disease · doi:10.1111/chd.12573 · Cited by 8 · see citing works
Gressies, C., Kaegi-Braun, N., Gomes, F., & Schuetz, P. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2022.11.007 · Cited by 5 · see citing works
- Authors
- Bonilla-Palomas, J. L., Gámez-López, A. L., Castillo-Domínguez, J. C., Moreno-Conde, M., López Ibáñez, M. C., Alhambra Expósito, R., Ramiro Ortega, E., Anguita-Sánchez, M. P., & Villar-Ráez, A.
- Affiliations
- Hospital San Juan de la Cruz (ES)
- Hospital Universitario Reina Sofía (ES)
- Venue
- Archives of Medical Research
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 47
- Issue
- 7
- Pages
- 535-540
- ISSN
- 0066-6769 (ISSN-L)
- 0188-4409
- OpenAlex
- W2593271198
- Cited by
- 196
- References
- 0
- Citations by year
- 2026: 25 · 2025: 25 · 2024: 25 · 2023: 22 · 2022: 27 · 2021: 20 · 2020: 14 · 2019: 18 · 2018: 16 · 2017: 3
- FWCI
- 10.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Medical Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sociedad Española de Cardiología
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- heart failure, malnutrition, dietary intervention, hospitalized patients, all-cause mortality, heart failure readmission, personalized nutrition, acute heart failure
- MeSH terms
- Acute Disease, Aged, Aged, 80 and over, Female, Heart Failure, Humans, Inpatients, Male, Mortality, Nutritional Status, Patient Readmission, Risk, Malnutrition
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