Feasibility and Effectiveness of a Multi-Micronutrient Intervention as a Palliative Care Therapy in Patients With Congestive Heart Failure

Abstract

ObjectivesVeterans with HF are at risk of micronutrient depletion due to combined systemic disease and drug induced altered nutrient disposition. This pilot aimed to test feasibility and effectiveness of a MMI to improve micronutrient status, cardiac function and quality of life in Veterans with HF. MethodsA pre/post repeated measures design was used. Veterans with stable HF stage B-D, left ventricular ejection fraction (LVEF) ≤45%, from ischemic cardiomyopathy with systolic dysfunction were recruited. The 6-month MMI was 3 tabs daily providing thiamin (B1) 100 mg, 50 mg each of riboflavin, niacin, pantothenic acid, pyridoxine (B6), inositol, 25 mg phosphatidyl choline, 400 mcg folic acid, and 50 mcg each of B12 and biotin, and 50 mg elemental zinc (Zn). Ergocalciferol was given as 50,000 IU weekly for 2 months then every 2 weeks for 4 months. Micronutrient status and LVEF (echocardiogram) were determined as least-squares mean (± standard error, SE) estimated from general linear mixed effect models fitted to micronutrient measurements adjusting for age (18–65 Vs. > 65); feasibility of MMI assessed as % consumed. ResultsThis abstract focuses on the nutrient status at baseline, feasibility of the MMI, and change in nutrient status following MMI. Twenty-two male Veterans (86% Caucasian), median 64 years (59–75 interquartile range, IQR) started MMI; 20 completed. At baseline, median (IQR) dietary intake was 1639 (1472–1838) calories, 36 (28–41) % fat, 13 (10–15) % saturated fat, 2981 (2067–3534) mg sodium while following the American Heart Association diet with 2 gm sodium restriction. Micronutrient intake was 1.2 (0.9–1.4) mg B1, 1.2 (1.0–1.8) mg B6, 49 (38–166) IU Vitamin D, and 7 (5–10) mg zinc. Median % compliance with MMI at 3 and 6 months was ≥ 92 and ≥94, respectively. Baseline and changes in blood measures of micronutrients were: B1, 119 (SE 13) and 96 (SE 20, p< 0.0001) nmol/L; B6, 11.4 (SE 6.3) and 57.3 (SE 9.2, p< 0.0001) ng/mL; total 25-OH Vitamin D, 31.2 (SE 2.3) and 6.5 (SE 3.4, p = 0.057) ng/mL; Zn, 81.4 (SE 5.1) and 13.8 (7.6, p = 0.07) mcg/dL. LVEF at baseline and 6 months were 28.9 (SE 1.6) % and 30.0 (SE 1.7) %, respectively (p = 0.64). ConclusionsThe feasibility of adding MMI to complex pharmaceutical regimens in male Veterans with stable HF was high. MMI was effective in improving micronutrient status and preserved LVEF. Funding SourcesDepartment of Veterans Affairs