Agreement and classification performance of malnutrition tools in patients with chronic heart failure

Background: Malnutrition is common in chronic heart failure (CHF) patients and is associated with adverse outcome, but few data exist. Objectives: To report the prevalence of malnutrition and classification performance of 6 malnutrition tools in CHF patients. Methods: Controlling nutritional status index (CONUT); geriatric nutritional risk index (GNRI); prognostic nutritional index (PNI); malnutrition universal screening tool (MUST); mini nutritional assessment-short form (MNA-SF); and subjective global assessment (SGA) were used to evaluate malnutrition. Since there is no “gold-standard” for malnutrition evaluation, for each of the malnutrition tools, we used the results of the other 5 tools to produce a standard combined index. Subjects were ‘malnourished’ if so identified by ≥3/5 tools. Results: We studied 467 consecutive ambulatory CHF patients (67% male, median age 76 (IQR: 69–82) years, median NTproBNP 1156 (IQR: 469–2463) ng/L). The prevalence of any degree and at least moderate malnutrition ranged between 6–60% and 3–9% respectively, with CONUT classifying the highest proportion of subjects as malnourished. Malnourished patients tended to be older, have worse symptoms, higher NT-proBNP and more co-morbidities. CONUT had the highest sensitivity (80%), MNA-SF and SGA had the highest specificity (99%) and MNA-SF had the lowest misclassification rate (2%) in identifying at least moderate malnutrition as defined by the combined index. Conclusion: Malnutrition is common in CHF patients. The prevalence of malnutrition varies depending on the tool used. Amongst the 6 malnutrition tool studied, MNA-SF has the best classification performance in identifying significant malnutrition as defined by the combined index.