Abstract 10754: Nutritional Status in Elderly Heart Failure is a Determinant of Functional Status and Readmission After Cardiac Rehabilitation: A Retrospective Cohort Study

Abstract

Introduction: The prevalence of malnutrition in elderly heart failure (HF) is high in cardiac rehabilitation (CR) settings. Malnutrition in elderly patients with chronic diseases admitted to hospitals is often associated with poor functional recovery in daily activities. However, there is few evidence of the impact of poor nutritional status on the effects of CR in HF patients. Hypothesis: We examined the hypothesis that nutritional status in elderly HF patients is a determinant of functional status and readmission after CR. Methods: One hundred ten HF patients at age of 65 years or older were included. All patients underwent CR during their hospitalization. Nutritional status and functional status were assessed by Mini Nutritional Assessment Short Form (MNA-SF) at the start of CR and Barthel Index score at discharge, respectively. The association between nutritional status and CR outcomes including functional status and the 1-year readmission rate were examined. Results: The medians of CR duration and sessions were 21 days and 11 sessions, respectively. Fifty-eight patients (53%) were malnourished (MNA-SF score ≦ 7). Patients with malnutrition had a lower Barthel Index score at discharge than those without malnutrition (median 85 vs. 90, p<0.01). Barthel Index score at discharge was lower in patients with chronic disease-related malnutrition, starvation-related malnutrition and acute disease or injury-related malnutrition. In multiple regression analysis, age, MNA-SF score, chronic disease-related malnutrition and starvation-related malnutrition were independent predictors of Barthel Index score at discharge (adjusted R 2 =0.20, p<0.01). The median follow up period was 150 days. Readmission due to worsening HF occurred in 55 patients (50%). The 1-year readmission rate by the Kaplan-Meier method was significantly higher in patients with malnutrition than those without malnutrition (p<0.05). Using Cox multivariate analysis adjusted for age and sex, BNP level, MNA-SF score and total lymphocyte count were independent predictors of the readmission (hazard ratio 2.58, 0.82, 0.99, respectively; p<0.05). Conclusions: Nutritional status in elderly HF patients is an important determinant of both functional status and readmission after CR.