European Primary Care Cardiovascular Society

Mortality in HF predicted by simple malnutrition scores

Prevalence and Prognostic Significance of Malnutrition Using 3 Scoring Systems Among Outpatients With Heart Failure. A Comparison With Body Mass Index

Sze S, Pellicori P, Kazmi S, et al. - J Am Coll Cardiol HF 2018; published online ahead of print

Introduction and methods

There are 3 malnutrition scores that have been studied in HF [1-4]:

There are data showing that each score identifies HF patients with various degrees of malnutrition, and that they predict outcomes, but it is not clear, whether the diagnostic rate of malnutrition and the predictive prognostic ability of the 3 scores differ.

In this study, the prevalence and prognostic importance of malnutrition was investigated, using the 3 different scores, in a large cohort of ambulatory HF patients referred to a specialized clinic between 2000 and 2016. The primary endpoint was all-cause mortality.

Main results


Moderate and severe malnutrition in HF patients, assessed with simple malnutrition scores, is associated with higher all-cause mortality, compared with HF patients without, or with mild malnutrition. Simple malnutrition scores were more closely related to outcome than BMI and the authors therefore conclude that BMI should not be used as surrogate of nutritional status in HF patients.

Editorial comment

In their editorial article, Kinugawa and Fukushima [6] discuss the limitations of the results of Sze et al, which include the single malnutrition assessment during the study, as well as the fact that the 3 indices used, might not reflect the true nutritional status in HF, as would have been the case with the validated and comprehensive Subjective Global Assessment or the Mini Nutritional Assessment. The authors conclude: ‘In conclusion, malnutrition defined by simple nutritional screenings is prevalent in outpatients with HF and provides a critical clue for stratifying patients with high mortality. Further research is warranted to verify whether nutrition-oriented management and intervention could reduce mortality and improve quality of life in patients with HF living in the era of an aging society.’


Show references

Find this article online at J Am Coll Cardiol HF