Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation

Masakazu Miura; Shinichi Okuda; Kazuhiro Murata; Hitoshi Nagai; Takeshi Ueyama; Fumiaki Nakao; Mototsugu Shimokawa; Takeshi Yamamoto; Yasuhiro Ikeda

doi:10.3389/fcvm.2021.764528

Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation

Front Cardiovasc Med. 2021 Dec 2:8:764528. doi: 10.3389/fcvm.2021.764528. eCollection 2021.

Authors

Masakazu Miura^{1

2}, Shinichi Okuda^{3

4}, Kazuhiro Murata¹, Hitoshi Nagai³, Takeshi Ueyama⁴, Fumiaki Nakao⁴, Mototsugu Shimokawa², Takeshi Yamamoto², Yasuhiro Ikeda⁴

Affiliations

¹ Department of Rehabilitation, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.
² Division of Nursing and Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.
³ Ultrasonography Center, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.
⁴ Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.

Abstract

Background: Hospitalized patients with acute decompensated heart failure (ADHF) frequently exhibit aggravating mitral regurgitation (MR). Those patients do not always undergo surgical mitral valve repair, but particularly in the elderly, they are often treated by conservative medical therapy. This study was aimed to investigate factors affecting 6-month outcomes in hospitalized patients with heart failure (HF) harboring surgically untreated MR. Methods: We screened the presence of MR in hospitalized patients with HF between September 2017 and May 2020 in the Yamaguchi Prefectural Grand Medical (YPGM) center. At the time of discharge of these patients, individuals with surgically unoperated MR, including primary and secondary origin, were consequently recruited to this single-center prospective cohort study. The patients with severe MR who undergo surgical mitral valve treatment were not included in this study. The primary endpoint was all-cause readmission or all-cause death and the secondary endpoint was HF-related endpoint at 6 months after discharge. The Cox proportional hazard regression analyses were employed to assess the predictors for the composite endpoint. Results: Overall, 489 patients with ADHF were admitted to the YPGM center. Of those, 146 patients (30% of total patients with HF) (median age 83.5 years, 69 men) were identified as harboring grade II MR or greater. Consequently, all the recruited patients were diagnosed as functional MR. During a median follow-up of 186.0 days, a total of 55 patients (38%) reached the primary or secondary endpoints (HF death and readmission in 31 patients, other in 24 patients). As a result of multivariate analysis, geriatric nutritional risk index [hazard ratio (HR) = 0.932; 95% CI = 0.887-0.979, p = 0.005], age (HR = 1.058; 95% CI = 1.006-1.112, p = 0.027), and left ventricular ejection fraction (HR = 0.971; 95% CI = 0.945-0.997, p = 0.030) were independent predictors of all-cause death or all-cause admission. Body mass index (HR = 0.793; 95% CI = 0.614-0.890, p = 0.001) and ischemic heart disease etiology (HR = 2.732; 95% CI = 1.056-7.067, p = 0.038) were also independent predictors of the HF-related endpoints. Conclusion: Malnutrition and underweight were substantial predictors of adverse outcomes in elderly patients with HF harboring surgically untreated moderate-to-severe functional MR.

Keywords: body mass index; frailty; functional mitral regurgitation (FMR); heart failure; malnutrition; older people.