article · Circulation
Protein-energy malnutrition is a frequent and often underdiagnosed condition in individuals with advanced heart failure who undergo heart transplantation. Analysing over 31,000 heart transplant hospitalisations from an inpatient database between 2016 and 2021, this research evaluated the influence of malnutrition on key clinical outcomes. Protein-energy malnutrition was documented in nearly twelve percent of these hospitalised recipients. The condition showed no statistically significant association with heart transplant rejection, graft failure, or cardiac allograft vasculopathy. However, patients with protein-energy malnutrition experienced substantially worse secondary clinical and economic outcomes compared to adequately nourished recipients. These included nearly three times higher odds of mortality, an increased occurrence of cardiac arrhythmias, a doubling of the median hospital stay from four to eight days, and roughly double the overall financial cost of hospitalisation.
Heart transplant recipients often cope with multiple co-existing conditions, but the precise impact of malnutrition on post-transplant complications has remained unclear. Demonstrating that malnutrition does not directly drive graft rejection, yet significantly raises mortality, complications, recovery duration, and medical expenses, highlights the importance of early nutritional assessment and management within advanced cardiac care pathways.
The abstract does not indicate a direct commercial application pathway. However, the findings offer an evidence base that could inform hospital nutrition protocols, clinical decision-support tools, and risk-stratification models for transplant programmes. Because the data stem entirely from a retrospective database analysis, any translation into standardised clinical products or care management pathways remains at an early, conceptual stage.
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Introduction: Heart transplant (HT) is the gold standard for advanced heart failure, and the individuals burdened by advanced heart failure often have multiple comorbidities. Protein-energy malnutrition (PEM) is a common comorbidity and is frequently underdiagnosed. Previous studies examined the relationship between PEM and mortality in HT and found a positive association. However, the relationship between PEM and HT rejection, HT failure, and cardiac allograft vasculopathy (CAV) is scarce. Given that these complications also impact survival, we sought to explore the relationship. Methods: We identified all HT patients using ICD-10 codes from the 2016 to 2021 National Inpatient Sample database. Then, the PEM group was compared to the no-PEM group. We used Student’s Test and Pearson’s Chi-squared to analyze continuous and categorical variables. Then, multivariable logistic regression models were used to account for confounders and to predict the outcomes. The primary outcomes were HT rejection, HT failure, and CAV. The secondary outcomes were mortality, arrhythmias (composite of atrial and ventricular fibrillation and flutter, and supraventricular tachycardia), length of hospital stay, and cost of hospitalization. A 2-sided p-value was the statistical threshold for significance. Results: During the study period, 31,215 HT hospitalizations occurred, and 11.9% (3,700) had PEM. The median age for the PEM group was 65 years. Compared to the no-PEM group, HT rejection 0.8 (0.4-1.5), HT failure 0.8 (0.3-2.1), and CAV 1.08 (0.6-1.9) did not differ between both groups, p>0.05, each. The PEM group had a higher association with mortality 2.8 (2.1-3.6), arrhythmias 1.4 (1.07-1.8), longer LOS 8 vs. 4 days, and higher cost of hospitalization, $84,687 vs. $43,285, p<0.01 each. Conclusion: Among the heart transplant population, protein-energy malnutrition was not associated with transplant rejection, transplant failure, or CAV. However, protein-energy malnutrition was associated with mortality, arrhythmias, a longer hospital stay, and a higher cost of hospitalization.
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DOI: 10.1161/circ.150.suppl_1.4147484
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