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Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure
Open accessAbstract
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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“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]
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“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, 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]
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“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]
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“The results underscore the potential benefits of personalized nutritional plans during hospitalizations, although this trial was not designed specifically for patients with CVDs”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [105]
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“This secondary analysis included all patients with chronic heart failure included in the EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients) trial (20,21).”
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Metadata
- 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)
- ORCID
- 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
- FWCI
- 16.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- 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 (medical) › 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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