Cited by 168Clinical Nutrition and GastroenterologyHeart Failure Treatment and ManagementNutrition and Health in Aging

Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure

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Hersberger, Lara, Dietz, Anna, Bürgler, Helene, Bargetzi, Annika, Bargetzi, Laura, Kägi-Braun, Nina, Tribolet, Pascal, Gomes, Filomena +14 more·2021·Journal of the American College of Cardiology

Abstract

Background Deterioration of nutritional status during hospitalization in patients with chronic heart failure increases mortality. Whether nutritional support during hospitalization reduces these risks, or on the contrary, may be harmful due to an increase in salt and fluid intake, remains unclear. Objectives The purpose of this trial was to study the effect of nutritional support on mortality in patients hospitalized with chronic heart failure who are at nutritional risk. Methods A total of 645 patients with chronic heart failure (36% [n = 234] with acute decompensation) participated in the investigator-initiated, open-label EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients) trial. Patients were randomized to protocol-guided individualized nutritional support to reach energy, protein, and micronutrient goals (intervention group) or standard hospital food (control group). The primary endpoint was all-cause mortality at 30 days. Results Mortality over 180 days increased with higher severity of malnutrition (odds ratio per 1-point increase in Nutritional Risk Screening 2002 score: 1.65; 95% confidence interval [CI]: 1.21 to 2.24; p = 0.001). By 30 days, 27 of 321 intervention group patients (8.4%) died, compared with 48 of 324 (14.8%) control group patients (odds ratio: 0.44; 95% CI: 0.26 to 0.75; p = 0.002). Patients at high nutritional risk showed the most benefit from nutritional support. Mortality effects remained significant at 180-day follow-up. Intervention group patients also had a lower risk for major cardiovascular events at 30 days (17.4% vs. 26.9%; odds ratio: 0.50; 95% CI: 0.34 to 0.75; p = 0.001). Conclusions Among hospitalized patients with chronic heart failure at high nutritional risk, individualized nutritional support reduced the risk for mortality and major cardiovascular events compared with standard hospital food. These data support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this vulnerable patient population. (Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial [EFFORT]; NCT02517476).

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Crossref · 10.1016/j.jacc.2021.03.232

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  • In a post hoc analysis of EFFORT participants with chronic heart failure, RDN-led tailored nutritional interventions were associated with lower 30-day mortality (odds ratio, 0.44 [95% CI, 0.26-0.75]; P=0.002), with a particularly marked effect among patients at highest risk by the Nutritional Risk Screening tool.

    “A post hoc analysis of participants with chronic HF demonstrated that the group receiving RDN-led deployment of tailored nutritional interventions experienced lower 30-day mortality (odds ratio, 0.44 [ 95% CI, 0.26–0.75]; P=0.002), with a particularly marked effect”

    From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [105]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Early nutritional support (provided in less than 48 h post hospital admission) compared to later nutritional support shall be performed in polymorbid medical inpatients, as mortality and adverse events are lower and lean body mass loss could be decreased and self-sufficiency could be improved.

    “Early nutritional support (i.e.provided in less than 48 h post hospital admission) compared to later nutritional support shall be performed in polymorbid medical inpatients, as mortality and adverse events are lower and lean body mass loss could be decreased and self-sufficiency could be improved.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [107]

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  • In patients with chronic heart failure included in the EFFORT trial, mortality over 30 days was 66% lower in the intervention group (OR 0.44, 95% CI 0.26 to 0.75; p=0.002).

    “In patients with chronic heart failure included in the EFFORT trial, Hersberger et al., 2021, reported that mortality over 30 days was 66% lower in the IG (OR 0.44 95% CI 0.26 to 0.75; p ¼ 0.002) [107].”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [107]

    The Results report lower 30-day mortality in the nutritional-support group and match the cited OR, confidence interval, and p-value. The stated 66% reduction is incorrect: an OR of 0.44 represents 56% lower adjusted odds, while the observed mortality rates were 8.4% versus 14.8%. (LLM, conf=0.94)

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  • 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 [107]

    The Results report significantly lower 30-day mortality with nutritional support in hospitalized patients with chronic heart failure, supporting the survival-benefit claim. However, the Methods identify the trial as EFFORT, not the NOURISH study named in the citing sentence. (LLM, conf=0.88)

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  • The EFFORT results underscore the potential benefits of personalized nutritional plans during hospitalizations.

    “The results underscore the potential benefits of personalized nutritional plans during hospitalizations, although this trial was not designed specifically for patients with CVDs”

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  1. [2]2. Bonilla Palomas J.L., Gamez Lopez A.L., Moreno Conde M., et al. [Impact of malnutrition on long-term mortality in outpatients with chronic heart failure]. Nutricion Hospitalaria 2017;34:1382-1389. PubMed Google Scholar a [...] in patients with chronic heart failure b [...] the population of heart failure patients

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Authors
Hersberger, L., Dietz, A., Bürgler, H., Bargetzi, A., Bargetzi, L., Kägi-Braun, N., Tribolet, P., Gomes, F., Hoess, C., Pavlicek, V., Bilz, S., Sigrist, S., Brändle, M., Henzen, C., Thomann, R., Rutishauser, J., Aujesky, D., Rodondi, N., Donzé, J., Stanga, Z., Mueller, B., & Schuetz, P.
Affiliations
  • University of Basel (CH)
  • Spital Lachen (CH)
  • New York Academy of Sciences (US)
  • Kantonsspital Münsterlingen (CH)
  • Kantonsspital St. Gallen (CH)
  • Luzerner Kantonsspital (CH)
  • Kantonsspital Baden (CH)
  • University of Bern (CH)
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2021-05
Volume
77
Issue
18
Pages
2307-2319
ISSN
0735-1097 (ISSN-L)
OpenAlex
W3158817249
Cited by
168
References
43
Citations by year
2026: 26 · 2025: 35 · 2024: 41 · 2023: 20 · 2022: 34 · 2021: 10 · 2012: 1
FWCI
16.82
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • ARBOR - Bern University of Applied Sciences Repository (submittedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
Funders
SNF
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
chronic heart failure, individualized nutritional support, malnutrition, all-cause mortality, major cardiovascular events, NRS-2002, acute decompensation, hospital food, malnutrition screening, frailty, functional outcome, hospitalized patients, mortality risk stratification
MeSH terms
Aged, Aged, 80 and over, Chronic Disease, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Nutritional Support

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