Nutritional support in the cardiac intensive care unit
Abstract
Optimal care of critically ill patients in the cardiac intensive care unit includes adequate nutritional support. This review highlights the high prevalence of malnutrition in acute heart failure, acute coronary syndrome, cardiogenic shock, and post-cardiac arrest and its adverse impact on prognosis. There is a lack of robust evidence regarding appropriate nutritional support in this patient population. Initiation of nutritional support with a comprehensive assessment of the patient’s nutritional status is critical. High-risk cardiac patients who are not critically ill can receive oral nutrition adapted to individual risk factors or deficiencies, although overfeeding should be avoided in the acute phase. For critically ill patients at risk of or with malnutrition on admission, general principles include initiation of nutritional support within 48 h of admission, preference for enteral over parenteral nutrition, preference for hypocaloric nutrition in the first week of intensive care unit admission, and adequate micronutrient supplementation. Enteral nutrition in haemodynamically unstable patients carries a risk, albeit low, of intestinal ischaemia. In the case of malnutrition, the risk of refeeding syndrome should always be considered.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Nutritional support plays a key role in the cardiac intensive care unit, where malnutrition is frequently encountered.
“Nutritional support plays a key role in the cardiac ICU (CICU), where malnutrition is frequently encountered.19”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [19]
Patients admitted with heart failure to the CICU often have poor nutrient absorption from mucosal edema, low cardiac output, inflammation, and neurohormonal activation with mesenteric vasoconstriction and microvascular dysfunction.
“Patients admitted with HF to the CICU often have poor nutrient absorption from mucosal edema, low cardiac output, inflammation, and neurohormonal activation with mesenteric vasoconstriction and microvascular dysfunction.19”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [19]
Enteral nutrition has lower rates of infection, overfeeding, and hyperglycemia compared with parenteral nutrition.
“EN is more cost-effective; has lower rates of infection, overfeeding, and hyperglycemia compared with PN19,134,135”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [19]
Higher metabolic demand in critically ill cardiac patients increases cardiac cachexia and sarcopenia risks, often coexisting with malnutrition and frailty, which negatively affects outcomes.
“Moreover, their higher metabolic demand increases cardiac cachexia and sarcopenia risks, often coexisting with malnutrition and frailty, which negatively affects outcomes.19,90”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [19]
Enteral nutrition is more cost-effective than parenteral nutrition.
“Enteral nutrition is more cost-effective compared with parenteral nutrition and can decrease mortality and shorten lengths of stay.”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [19]
Newer data demonstrated no difference in complications with early enteral nutrition (<48 hours) even during targeted temperature management.
“newer data demonstrated no difference in complications with early EN (<48 hours) even during targeted temperature management.19,174–177”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [19]
Venoarterial extracorporeal membrane oxygenation carries a significantly higher risk of mesenteric ischemia, as high as 5% to 9%, in contrast to 1% to 2% when vasoactive agents alone are used.
“advanced mechanical circulatory support such as venoarterial extracorporeal membrane oxygenation carries a significantly higher risk of mesenteric ischemia, as high as 5% to 9%,19,161 in contrast to 1% to 2% when vasoactive agents alone are used.158”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [19]
Cites
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
Reignier, J., Boisramé-Helms, J., Brisard, L., Lascarrou, J.-B., Ait Hssain, A., Anguel, N., Argaud, L., Asehnoune, K., Asfar, P., Bellec, F., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)32146-3 · Cited by 595 · see citing works
Heyland, D. K., Patel, J., Compher, C., Rice, T. W., Bear, D. E., Lee, Z.-Y., González, V. C., O'Reilly, K., Regala, R., Wedemire, C., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(22)02469-2 · Cited by 401 · see citing works
Reignier, J., Plantefeve, G., Mira, J.-P., Argaud, L., Asfar, P., Aissaoui, N., Badie, J., Botoc, N.-V., Brisard, L., Bui, H.-N., et al. (2023) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(23)00092-9 · Cited by 270 · 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
Fehler, P., Zielińska, M., Uchmanowicz, B., Juárez-Vela, R., Lewandowski, Ł., Zieliński, S., & Czapla, M. (2023) · Nutrients · doi:10.3390/nu15020436 · Cited by 10 · see citing works
Tsai, Y.-C., Yin, C.-H., Chen, J.-S., Chen, Y.-S., Huang, S.-C., & Chen, J.-K. (2024) · Journal of Microbiology, Immunology and Infection · doi:10.1016/j.jmii.2023.12.007 · Cited by 9 · see citing works
Kim, G. W., Roh, Y.-I., Cha, K.-C., Hwang, S. O., Han, J. H., & Jung, W. J. (2022) · Acute and Critical Care · doi:10.4266/acc.2022.00696 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
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
Nutrition Optimization Among Critically Ill Patients in the Cardiac Intensive Care Unit
Allaparthi, S., Bode, A., Bury, C., & Vest, A. R. (2025) · Current Cardiology Reports · doi:10.1007/s11886-025-02208-9 · Cited by 5 · see citing works
“Malnutrition in the setting of a recent hospitalization for HF was also investigated in the PICNIC trial, with the patients receiving an individualized nutritional intervention in addition to conventional HF treatment showing lower readmission and mortality rates [51].”
InfluentialFluid balance after cardiac arrest: Any impact on outcome? Insights from the MIMIC IV database
Didier, J., Murris, J., Schopper, H., Guérin, E., Flajoliet, N., Amiot, M., Hermann, B., Germain, S., Cariou, A., Diehl, J., et al. (2025) · Resuscitation Plus · doi:10.1016/j.resplu.2025.101037 · Cited by 3 · see citing works
Duan, J., Shi, Y., Du, Y., Li, D., Duan, B., & Wang, G. (2026) · Journal of Intensive Care · doi:10.1186/s40560-026-00861-y · Cited by 3 · see citing works
“Following CA, the combination of severe intestinal ischemia and hypoxia with subsequent persistent hypoperfusion due to high-dose vasoactive agents often leads to intestinal dysfunction, frequently manifesting as feeding intolerance caused by impaired motility [5, 6].”
InfluentialClinical implications of malnutrition on 30-day adverse events in patients with Takotsubo syndrome
Onishi, K., Matsumura, K., Yagi, E., Yamada, N., Funauchi, Y., Kakehi, K., Yoshida, A., Fujita, K., Kawamura, T., Matsuzoe, H., et al. (2025) · Journal of Cardiology · doi:10.1016/j.jjcc.2025.03.004 · Cited by 1 · see citing works
Elay, G., & Güven, A. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15062310 · Cited by 1 · see citing works
“Although an association between nutritional risk and outcomes in patients with post-cardiac arrest has been reported, evidence on the independent prognostic contribution of m-NUTRIC, specifically in IHCA, remains limited [11,12].”
Elmorsy, E., Sobh, Z., Alenazi, S., Alfdeed, G. R. H., Alruwaili, S. K. D., & Sharif, A. (2026) · Annales de Toxicologie Analytique · doi:10.1016/j.toxac.2026.01.003 · Cited by 1
Ventricular Dysfunction Secondary to Refeeding Syndrome in an Infant, A Case Report
Aristizábal, A., Guzmán-Serrano, C. A., Ariza-Insignares, C., Guzmán, G., Guerrero, C., & Cely, C. (2024) · International Journal of Child Health and Nutrition · doi:10.6000/1929-4247.2024.13.04.3 · Cited by 1
Wang, S., Zhang, Y., Yuan, Y., Huang, C., & Chen, Z. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1916756
Tong, K., Fang, D.-L., Xie, Y.-C., & Cai, M.-Q. (2026) · Scientific Reports · doi:10.1038/s41598-026-65431-6
Zhang, C.-G., Zhang, M.-Q., Chen, X.-Y., Mu, X.-D., Yin, H., Li, J., Yang, H., & Wu, S. (2026) · Scientific Reports · doi:10.1038/s41598-026-50053-9
“Given the established association between nutritional status and the prognosis and mortality of various diseases, including cardiovascular disease and cancer, an increasing number of studies have emphasized the importance of nutritional status screening in clinical practice 1–3,19, 20 .”
Micronutrient Deficiencies in Heart Transplant Recipients—Scoping Review
Ławniczek, M., Habryka, J., & Krupa-Nurcek, S. (2026) · Nutrients · doi:10.3390/nu18101485
“Early identification of these risks, regular assessment of nutritional status, and targeted supplementation are key elements of comprehensive care for transplant recipients and can significantly improve their prognosis and quality of life [70,73,83].”
Kaner, G., Ayer, Ç., & Karakuş, Z. (2026) · Galician Medical Journal · doi:10.21802/e-gmj2026-a07
Ido, T., Hayashi, T., Yamada, T., Nakamoto, K., Sotomi, Y., & Higuchi, Y. (2025) · Circulation Reports · doi:10.1253/circrep.cr-25-0113
Jia, L., Yu, J., Lin, S., Ye, D., & Shen, Y. (2025) · Nursing in Critical Care · doi:10.1111/nicc.70186
“Adequate nutritional support has been shown to be an essential component of optimal care for critically ill patients in the CICU [42].”
Correlation between the NRS-2002 score and PD-1/CTLA-4 levels in patients with CAP
Zhang, C. (2025) · medRxiv · doi:10.1101/2025.02.19.25322531
Refeeding Syndrome: Review Article
Solis-Loria, W. A., Solís-Loría, P. V., Dueñas-Sosa, M., Rivas-Rivas, F. R., Herrera-Villalobos, J. E., Bautista-Crescencio, C. E., Cambray-Guerra, R., Moreno-López, R., Uribe-Zapata, E. O., Fernández-Gómez, S., et al. (2025) · Journal of Anesthesia & Critical Care: Open Access · doi:10.15406/jaccao.2025.17.00621
Management of Malnutrition in Heart Failure to Optimize Guideline-Directed Medical Therapy
Liu, T., & Lip, G. (2025) · Cardiovascular Innovations and Applications · doi:10.15212/cvia.2025.0021
- Authors
- Frederiks, P., Peetermans, M., & Wilmer, A.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- Corresponding author
- Wilmer, Alexander
- Venue
- European Heart Journal: Acute Cardiovascular Care
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-02-09
- Volume
- 13
- Issue
- 4
- Pages
- 373-379
- ISSN
- 2048-8726 (ISSN-L)
- 2048-8734
- OpenAlex
- W4391684754
- Cited by
- 14
- References
- 0
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 1
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal Acute Cardiovascular Care (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Keywords
- nutritional support, cardiac intensive care, malnutrition, acute heart failure, acute coronary syndrome, cardiogenic shock, post-cardiac arrest, nutritional assessment, enteral nutrition, parenteral nutrition, hypocaloric diet, micronutrient supplementation, intestinal ischemia, refeeding syndrome, critically ill patients
- MeSH terms
- Coronary Care Units, Critical Care, Enteral Nutrition, Humans, Intensive Care Units, Nutritional Status, Critical Illness, Nutritional Support, Malnutrition
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
