Association between nutritional intake and 1-year all-cause mortality in patients with aortic stenosis undergoing transcatheter aortic valve implantation

Abstract

Background & aims: The relationship between energy intake and the long-term prognosis of patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis is poorly understood. We aimed to investigate the impact of energy intake before hospital discharge on the long-term prognosis of patients undergoing TAVI.

Methods: This single-centre retrospective observational study included patients who underwent TAVI for aortic stenosis. Patients on haemodialysis, on protein-restricted diets, with no oral intake before discharge, and those who experienced in-hospital death were excluded. Energy intake during the 3 days prior to discharge was assessed by a nutritionist based on a visual assessment by a nurse. Patients were classified into two groups with a cutoff value of 25 kcal/kg/day energy intake. Propensity score matching was performed to adjust for age, sex, and body mass index between the two groups. The primary endpoint was all-cause mortality within 1 year.

Results: Out of 312 consecutive patients, the study population included 132 patients (median age, 85 years; 68 % women) following propensity score matching. The all-cause mortality within 1 year was 10 % (13 of 132 patients). No significant differences in baseline patient characteristics were noted between patients with energy intake ≥25 and <25 kcal/kg/day, except for diabetes. Compared to patients with energy intake ≥25 kcal/kg/day, those with energy intake <25 kcal/kg/day had a significantly higher 1-year mortality rate (16.7 % vs. 3.0 %, log-rank test p < 0.01). In multivariate analysis using a Cox proportional hazards model adjusted for age, diabetes mellitus, serum creatinine, and transfemoral approach, energy intake <25 kcal/kg/day was independently associated with 1-year mortality (hazard ratio, 7.11; 95 % confidence interval 1.53-33.03, p = 0.01).

Conclusion: Low energy intake during the predischarge phase is associated with long-term prognosis in patients undergoing TAVI. Nutritional support for patients with a low energy intake and careful follow-up after discharge should be considered.

Keywords: Aortic stenosis; Energy intake; Malnutrition; Transcatheter aortic valve implantation.