Nutritional Assessment and Management in Heart Failure Patients

Heart failure is characterised by a complex interplay between altered haemodynamics, systemic inflammation and metabolic derangements that predispose patients to malnutrition, sarcopenia and cachexia. Impaired appetite, gastrointestinal congestion and increased resting energy expenditure converge to create a catabolic state, which in turn exacerbates cardiac dysfunction and heightens the risk of hospitalisation and mortality. Nutritional assessment has evolved from simple anthropometry to the routine use of objective indices—such as the Controlling Nutritional Status score, Geriatric Nutritional Risk Index and Prognostic Nutritional Index—which integrate biochemical and cellular parameters. Early identification of at‐risk individuals enables tailored dietary and pharmacological interventions, including optimisation of protein and energy intake, micronutrient supplementation and anti‐inflammatory strategies. Multidisciplinary management that combines cardiology, dietetics and rehabilitation fosters preservation of lean mass, improves functional capacity and may attenuate adverse remodelling. In low‐resource settings, point‐of‐care screening tools facilitate risk stratification and have global applicability. Emerging evidence supports the incorporation of nutritional endpoints into heart failure guidelines, underscoring the central role of metabolic care alongside neurohormonal blockade and device therapy.

Research from Nature Portfolio

Recent studies have demonstrated that higher CONUT scores on admission correlate with increased in‐hospital mortality and infection risk in acute decompensated heart failure. Multicentre registry analyses have elucidated a stepwise relationship between worsening serum albumin, lymphocyte count and cholesterol levels and adverse clinical outcomes during the index hospitalisation. These findings reinforce the prognostic value of early nutritional screening and support its integration into standard care pathways to guide timely interventions.

Nutritional Assessment and Management in Heart Failure Patients publication trend

The graph below shows the total number of articles in nutritional assessment and management in heart failure patients across all publications each year (not limited to Nature Index journals).

Technical terms

Controlling Nutritional Status (CONUT) score: An index combining serum albumin, lymphocyte count and cholesterol levels to quantify nutritional risk.

Geriatric Nutritional Risk Index (GNRI): A tool using serum albumin and the ratio of actual to ideal body weight to assess nutritional risk in elderly patients.

Prognostic Nutritional Index (PNI): A score derived from serum albumin and lymphocyte count that reflects both nutritional and inflammatory status.

Left ventricular ejection fraction (LVEF): The percentage of blood volume ejected from the left ventricle during systole, serving as a key measure of cardiac function.

B-type natriuretic peptide (BNP): A hormone released by ventricular myocardium in response to stretch, widely used as a biomarker of heart failure severity.

References

1. Association with Controlling Nutritional Status (CONUT) Score and In-hospital Mortality and Infection in Acute Heart Failure. Scientific Reports (2020).
2. The clinical value of the Controlling Nutritional Status score for predicting prognosis in systolic heart failure cases in the vulnerable phase. Frontiers in Nutrition (2023).
3. Interrelationship between Altered Left Ventricular Ejection Fraction and Nutritional Status in the Post-Acute Myocardial Infarction Patient. Nutrients (2024).
4. Nutritional interventions for heart failure patients who are malnourished or at risk of malnutrition or cachexia: a systematic review and meta-analysis. Heart Failure Reviews (2020).