1. Prognostic Impact of Change in Nutritional Risk on Mortality and Heart Failure After Transcatheter Aortic Valve Replacement
- Author
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Javier López Pais, Ana Belen Cid Alvarez, Marta Perez Poza, Mária Juskowa, José Ramón González Juanatey, Rocío González Ferreiro, Xoan Carlos Sanmartín Pena, Ignacio Cruz-González, Pedro Luis Sánchez Fernández, Óscar Otero García, Diego López Otero, Leyre Álvarez Rodríguez, Ramiro Trillo Nouche, Carla Eugenia Cacho Antonio, and Pablo José Antúnez Muiños
- Subjects
Heart Failure ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Nutritional status ,Aortic Valve Stenosis ,medicine.disease ,Prognosis ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,Malnutrition ,Treatment Outcome ,Valve replacement ,Risk Factors ,Internal medicine ,Heart failure ,Aortic Valve ,medicine ,Cardiology ,Humans ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,business ,Nutritional risk - Abstract
Background: Limited data are available regarding change in the nutritional status after transcatheter aortic valve replacement (TAVR). This study evaluated the prognostic impact of the change in the geriatric nutritional risk index following TAVR. Methods: TAVR patients were analyzed in a prospective and observational study. To analyze the change in nutritional status, geriatric nutritional risk index of the patients was calculated on the day of TAVR and at 3-month follow-up. The impact of the change in nutritional risk index after TAVR on all-cause mortality, heart failure hospitalization (HF-h), and the composite of all-cause death and HF hospitalization was analyzed using the Cox Proportional Hazards model. Results: Four hundred thirty-three patients were included. After TAVR, 68.4% (n=182) patients with baseline nutritional risk improved compared with 31.6% (n=84) who remained at nutritional risk. The change from no-nutritional risk to nutritional risk after TAVR occurred in 15.0% (n=25), while 85.0% (n=142) remained without risk of malnutrition. During follow-up, 157 (36.3%) patients died and 172 patients (39.7%) were hospitalized due to HF. Patients who continued to be at nutritional risk had a higher risk of mortality (hazard ratio [HR], 2.10 [95% CI, 1.30–3.39], P =0.002), HF-h (HR, 1.97 [95% CI, 1.26–3.06], P =0.000), and the composite of death and HF-h (HR, 2.0 [95% CI, 1.37–2.91], P P =0.003), HF-h (HR, 0.50 [95% CI, 0.34–0.74], P =0.001), and the composite outcome (HR, 0.44 [95% CI, 0.32–0.62], P Conclusions: Remaining at nutritional risk after TAVR confers a poor prognosis and is associated with an increased risk of mortality and HF-h, while the change from risk of malnutrition to non-nutritional risk after TAVR was associated with a halving of the risk of mortality and HF-h. Further studies are needed to identify whether patients at nutritional risk would benefit from nutritional intervention during processes of care of TAVR programs.
- Published
- 2021