Abstract
Background and objectives: Nutritional disorders are common in patients with heart failure (HF) and are associated with reduced functional capacity and poor prognosis. In this study, we evaluated the prognostic, nutritional and functional impact of a structured nutritional intervention in patients with chronic HF at risk of malnutrition. Methods: This is a prespecified subanalysis of the randomized controlled trial Prognostic And Clinical iMpAct of a Nutritional intervention in patients with chronic HF (PACMAN-HF). Ambulatory patients with chronic HF at risk of malnutrition were identified using the Mini Nutritional Assessment (MNA) questionnaire and randomized to receive either an individualised nutritional intervention (intervention group) or standard care (control group). We evaluated the frequency of malnutrition risk and the impact of the intervention on clinical outcomes, defined as a composite of all-cause mortality or time to first HF hospitalisation, as well as nutritional status and functional capacity at 3- and 12-month follow-ups. Results: A total of 225 patients were screened. Of these, 72 (32%) were identified as being at risk of malnutrition and 64 (28.4%) met the inclusion criteria and were randomized (31 in the intervention group and 33 in the control group). There were no significant differences between the groups in terms of all-cause mortality or time to first HF hospitalisation (HR = 0.34 [0.11-1.09]; p = 0.072). At 12 months, the intervention group demonstrated a significant improvement in functional capacity, with an increase of 31.3 metres in the 6-minute walk test (6MWT) (p = 0.002), whereas no significant change was observed in the control group. Nutritional status improved significantly in the intervention group (MNA score +4.12, p < 0.001) and declined in the control group (-1.15, p = 0.029). At 12 months, body mass index, tricipital skinfold thickness, arm circumference, and serum albumin levels increased in the intervention group. Conclusions: A structured and individualised nutritional intervention significantly improved nutritional status and functional capacity over 12 months, although it did not impact major clinical outcomes.