Poor Nutritional Status Predicts Mortality in Patients With Acute Heart Failure Admitted to the Cardiac Intensive Care Unit: A Retrospective Cohort Study

Abstract

Purpose: This study aims to identify factors predicting mortality, including nutritional status, in patients with acute heart failure (AHF) admitted to the cardiac intensive care unit and to explore the implications of accurate early nutritional assessment. Methods: This retrospective cohort study performed a secondary analysis of data from 357 patients admitted to a tertiary hospital in Seoul, Korea, from 2019 to 2022. The target patients were classified into high-risk and low-risk groups through the Nurses' nutritional assessment (NNA) using three questions and into normal, mild, moderate, and severe risk groups using the Nutritional Risk Index (NRI) including serum albumin. Kaplan–Meier survival and Cox proportional hazards regression analyses were performed. Results: The patients’ average age was 65.6 ± 14.9 years and 68.1% were men. During the study period, 19.6% (n = 70) of the patients died. Mortality differed significantly according to the groups of NNA and NRI (log-rank, p < .001). However, no correlation was found between the NNA and NRI results (χ2 = 3.24, p = .362). High-risk group by NNA [hazard ratio (HR: 3.32, 95% confidence interval (CI): 1.86–5.95, p < .001)] and severe risk group by NRI (HR: 2.56, 95% CI: 1.07–6.13, p = .035), presence of diabetes (HR: 1.89, 95% CI: 1.07–3.36, p = .030), and low mean arterial pressure (HR: 0.97, 95% CI: 0.96–0.99, p = .004) were significant predictors. Conclusion: Poor nutritional status, along with the presence of diabetes and lower mean arterial pressure, predicted mortality in patients with AHF admitted to the cardiac intensive care unit. Nurses need to integrate objective data, such as serum albumin, into the initial nutritional assessment of patients admitted to the intensive care unit, and provide continuous attention and monitoring for patients with poor nutrition.