title: Review of nutritional screening and assessment tools and clinical outcomes in heart failure.
abstract: Recent studies have suggested that undernutrition as defined using multidimensional nutritional evaluation tools may affect clinical outcomes in heart failure (HF). The evidence supporting this correlation is unclear. Therefore, we conducted this systematic review to critically appraise the use of multidimensional evaluation tools in the prediction of clinical outcomes in HF. We performed descriptive analyses of all identified articles involving qualitative analyses. We used STATA to conduct meta-analyses when at least three studies that tested the same type of nutritional assessment or screening tools and used the same outcome were identified. Sensitivity analyses were conducted to validate our positive results. We identified 17 articles with qualitative analyses and 11 with quantitative analysis after comprehensive literature searching and screening. We determined that the prevalence of malnutrition is high in HF (range 16-90 %), particularly in advanced and acute decompensated HF (approximate range 75-90 %). Undernutrition as identified by multidimensional evaluation tools may be significantly associated with hospitalization, length of stay and complications and is particularly strongly associated with high mortality. The meta-analysis revealed that compared with other tools, Mini Nutritional Assessment (MNA) scores were the strongest predictors of mortality in HF [HR (4.32, 95 % CI 2.30-8.11)]. Our results remained reliable after conducting sensitivity analyses. The prevalence of malnutrition is high in HF, particularly in advanced and acute decompensated HF. Moreover, undernutrition as identified by multidimensional evaluation tools is significantly associated with unfavourable prognoses and high mortality in HF.
authors.affiliation: Nanjing Medical University School of Nursing, Nanjing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China.
authors.forename: Xinli
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China.
authors.forename: Xiangqin
authors.initials: X
authors.lastname: Kong
authors.affiliation: Nanjing Medical University School of Nursing, Nanjing, China. gzsun100@163.com.|Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China. gzsun100@163.com.
authors.forename: Gouzhen
authors.identifier: 0000-0003-4242-391X
authors.initials: G
authors.lastname: Sun
mesh_terms: D000368:Aged; D015577:Geriatric Assessment; D006333:Heart Failure / Q000150:complications* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis*; D015596:Nutrition Assessment; D009752:Nutritional Status; D012307:Risk Factors
keywords: Clinical outcomes; Heart failure; Nutritional assessment; Nutritional screening