Sun. Apr 21st, 2024

The Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Society of Cardiology (SEC) have prepared a document entitled “Assessment of Disease-Related Malnutrition (DRE) and sarcopenia in patients with heart failure (HF)” , whose objective is to establish the bases for a structured valuation in the heart failure patient that may also suffer Illness-Related Malnutrition and/or sarcopenia.
Heart failure is a serious disease in which the heart is unable to pump enough blood as the body demands. This malfunction will produce the characteristic symptoms and signs of this disease: dyspnea, fatigue and fluid retention. Heart failure is a problem of increasing magnitude and whose severity greatly impairs the prognosis and quality of life of patients. It is estimated that the median survival of patients with advanced degrees of heart failure is less than that of many types of cancer, with frequent admissions due to decompensation, prolonged and expensive, which produce a significant economic impact on health systems. The chronic heart failure It is characterized by the development of systemic venous congestion, secondary to right heart dysfunction that predisposes to intestinal edema, inflammatory activation, and malabsorption, thus leading to malnutrition and cachexia.

Heart failure can lead to sarcopenia

“Survival and quality of life depend not only on heart disease, but also on global assessment and treatment,” says Dr. Ana Zugasti, member of the Nutrition Department of the Spanish Society of Endocrinology and Nutrition (SEEN). The endocrinologist refers to various studies at the national level in which it is evident that the prevalence of la DRE in patients with heart failure is estimated at 18.6%. The incidence is higher in patients with preserved Ejection Fraction (EF, percentage of blood that leaves the heart each time it contracts) (23%) than in those with reduced EF (15.9%). DRE carries a worse prognosis in HF patients. Likewise, Dr. Zugasti indicates that heart failure “can lead to sarcopeniaa condition that causes loss of muscle mass, strength, and function in older adults, through common pathogenic pathways such as hormonal changes, malnutrition, and physical inactivity, and can also be the origin of HF ” and adds: “Sarcopenia is also quite prevalent in patients with HF, so both conditions (DRE and sarcopenia) could benefit from common treatment strategies.” Therefore, the approach to DRE and sarcopenia in cardiac rehabilitation and in multidisciplinary teams that treat patients with HF is essential. This document arises for the cardiac rehabilitation units but it can be very useful for the detection of DRE and initial management in multidisciplinary teams that care for people with HF and achieve the best prognosis and quality of life. Once the DRE is detected, the endocrinologist is the specialized physician trained to carry out a morphofunctional assessment and adjust the nutritional medical treatment that the patient needs. “It is essential to participate in the diagnosis and treatment of patients with HF who present DRE and sarcopenia, in the context of agile and correctly defined intervention protocols in each center with the means available”, explains Dr. Zugasti. It should be noted that these are patients with complex pathologies that require progressive medication adjustments, as well as nutritional treatment.

Nutritional recommendations for the patient with heart failure

The specialist emphasizes that it is necessary for the diet of these patients to provide a sufficient caloric and protein intake. The current recommendations encrypt a contribution of 27 kcal/kg/day and 1.5 g/protein/kg/day in the context of a Mediterranean diet pattern. In addition, it is essential to take into account the distribution throughout the day “to achieve minimal peaks that stimulate protein synthesis.” Dr. Zugasti emphasizes that the nutritional medical treatment be carried out jointly with a exercise plan appropriate to the functional capacity of the patient. The symptoms that patients with these pathologies may present are “lack of appetite, “slow” digestions, swollen feet, some shortness of breath, tiredness and weakness to perform tasks at home, as well as less ability to practice of exercise”. The endocrinologist points out that it is essential to consider a nutritional and functional assessment in the periodic evaluation to rule out DRE and sarcopenia: “We must review the weight evolution in the last months, the quantity and the variety in the dietary intake, together with anthropometric parameters of body composition and functionality”. In relation to the challenges in this area for professionals, the endocrinologist maintains that they seek to design agile and practical care protocols in order that “the patient receives the best multidisciplinary care through the least number of visits and time possible together with the combination of face-to-face assistance and remote monitoring and training”. Dr. Zugasti expresses her satisfaction because “many cardiac rehabilitation teams have incorporated the assessment of body composition into their regular clinical practice.” However, the specialist claims that the regulated assessment of sarcopenia “It is not so established and, especially, the medium-long term follow-up.”

Dietary recommendations and physical exercise

“In the first months of treatment, changes in lifestyle can be remarkable, but the patient must understand that the dietary recommendations and physical exercise they have to be maintained in the long term, since the affectation is not limited to their heart, but it is the metabolic and functional state of their organism that will determine their survival and their quality of life”, he concludes. For their part, Dr. Vicente Arrarte and Dr. Raquel Campuzano, from the SEC, maintain that “thehe patients with HF are the ones who benefit the most from cardiac rehabilitation. An initial approach to DRE and sarcopenia in such programs greatly improves the prognosis and quality of life for patients.” As Dr. Zugasti points out, “this document makes it possible to structure said management and proposes teamwork in the treatment of DRE and sarcopenia counting on the participation of Clinical Nutrition Units of multi-professional teams”. In this sense, the doctor highlights the important work of the Virtual Classrooms of the SEEN and AulaRC of the SEC created so that the patient and his environment “have a greater knowledge about the pathology, the alarm symptoms and how they can change their habits and improve their clinical status.

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