Nutritional Risk and Mortality at One Year for Elderly Patients Hospitalized with Nonvalvular Atrial Fibrillation. NONAVASC Registry

Abstract

Objectives

To determine whether nutritional risk is associated with the mortality of elderly patients hospitalized with nonvalvular atrial fibrillation (NVAF).

Design

Prospective, multicenter cohort study.

Setting

Internal medicine departments in Spain.

Participants

Inpatients >75 years with NVAF.

Measurements

We measured the thrombotic and hemorrhagic risk at admission using the CHA2DS2-VASc and HAS-BLED scales, respectively, and the nutritional risk with the controlling nutritional status (CONUT) index. We established 4 degrees of nutritional risk: null (CONUT score 0–1 point), low (2–4 points), moderate (5–8 points) and high (9–12 points). We also conducted a 1-year follow-up.

Results

We included 449 patients, with a mean age of 85.2(5.2) years. The nutritional risk was null for 70(15.6%) patients, low for 206 45.9%), moderate for 152(33.8%) and high for 21(4.7%). At the end of one year, 177(39.4%) patients had died. The score on the CONUT index was higher for the deceased patients (4.6 vs. 3.6, p<0.001). The CONUT score (HR, 1.076; 95%CI 1.009–1.148; p=0.025), the Charlson index (HR, 1.080; 95%CI 1.017–1.148; p=0.013) and the presence of pressure ulcers (HR, 1.700; 95%CI 1.028–2.810; p=0.039) were independently associated with increased mortality at one year of follow-up. The prescription of oral anticoagulants at discharge was associated with lower mortality (HR, 0.440; 95%CI 0.304–0.638; p<0.001).

Conclusions

More than a third of elderly patients hospitalized with NVAF have a moderate to high nutritional risk. These patients have greater mortality at the end of one year.

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Acknowledgements

Researchers of the NONAVASC study; Vascular Risk Group of the Spanish Society of Internal Medicine. I. García-Polo, JC. Arévalo-Lorido, J. Portillo-Sánchez, I. Martínez-Moreno, C. de la Guerra-Acebal, C. Argüello-Martín, SI. Aranda-Sánchez, I. Novo-Veleiro, M. Pena-Seijo, F. Salgado-Ordoñez, JA. Vargas-Hitos, J. González-Moraleja, NR. Tobares-Carrasco, P. Freixas-Descarrega, I. Campodarve-Botet, C. Fernández-Capitán, LM. Palomar-Rodríguez, AB. Gómez-Belda, D. Chivite-Guillén, MA. Rico-Corral, JL. Hernández-Hernández, E. Coloma-Bazán, X. Sobrino-Martínez, J. Grandes-Ibáñez, M. Martín-Millán, R. Cuenca-Acevedo, JB. Pérez-Lorenz, A. de la Peña Fernández, G. López-Castellanos, E. Montero-Hernández, E. Calderón-Sandubete, C. Lahoz-Rallo, A. de los Santos-Moreno, JA. Martínez-Muradas, J. Alfonso-Megido, JI. Cuende-Melero, R. Cotos-Cancas, JJ. Tamarit-García, F. Bonilla-Rovira, A. Epalza-Bueno, M. Morales-Conejo, L. Manzano-Espinosa, S. FreireCastro, A. RodríguezGonzález, M. Menduiña-Guillén, A. López-Suárez, JF. Sánchez Muñoz-Torrero, MD. Martín-Escalante, JA. Ortiz-Minuesa, JC. Martínez-Acitores, MB. Alonso-Ortiz, D. Filella-Agulló, H. Ágreda-López, M. Romero-Jiménez, ME. Fernández-Pérez, JL. Díaz-Díaz, C. Pérez-Bocanegra, R. Martínez-Fernández, JA. Nieto-Rodríguez, J. Masferrer-Serra, L. Mérida-Rodrigo, JM. Varela-Aguilar, A. Mujal-Martínez, L. Castilla-Guerra, P. Castellanos-Llauger, G. Tiberio-López, E. Guevara-Sierra y J. Fernández-Pardo.

Funding

Funding: The NONAVASC study was funded by an unconditional grant from Bayer.

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Authors

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Contributions

Authors contributions: Antonio Pose Reino, Francesc Formiga, Miguel Camafort, José María Cepeda Rodrigo, José María Mostaza, Carmen Suárez Fernández and Jesús Díez-Manglano designed the study. All authors participated in the data collection. Aranzazu Arenas Miquélez, Maria Angeles Requena Calleja and Jesús Díez-Manglano analyzed the data and drafted the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Jesús Díez-Manglano.

Ethics declarations

Conflicts of interest: The authors declare that they have no conflict of interest. Aranzazu Arenas Miquelez has no conflict of interest. María Ángeles Calleja Requena has no conflict of interest. Alejandra Gullón has no conflict of interest. Antonio Pose Reino has no conflict of interest. Françesc Formiga has no conflict of interest. Miguel Camafort has no conflict of interest. José María Cepeda Rodrigo has no conflict of interest. José María Mostaza has no conflict of interest. Carmen Suárez Fernández has no conflict of interest. Jesús Díez-Manglano has no conflict of interest.

Ethics approval The study was approved by the Ethics Committee for Clinical Research of University Hospital de la Princesa (Madrid, Spain).

Additional information

Consent to participate: All patients, or their relatives in the event of cognitive impairment, gave their written informed consent.

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Arenas Miquélez, A., Requena Calleja, M.A., Gullón, A. et al. Nutritional Risk and Mortality at One Year for Elderly Patients Hospitalized with Nonvalvular Atrial Fibrillation. NONAVASC Registry. J Nutr Health Aging (2020). https://doi.org/10.1007/s12603-020-1418-0

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Key words

  • Atrial fibrillation
  • nutrition
  • elderly
  • mortality
  • cohort study