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Nutritional assessment and support of the patient with acute heart failure

Sarma, Satyam; Gheorghiade, Mihai

Current Opinion in Critical Care: October 2010 - Volume 16 - Issue 5 - p 413–418
doi: 10.1097/MCC.0b013e32833e10d4
Cardiovascular system: Edited by Gerasimos Filippatos

Purpose of review: A significant number of patients hospitalized with heart failure are malnourished. Depletion of micronutrients, which is known to occur in heart failure for a variety of reasons, may contribute to myocardial abnormalities noted in heart failure. In this review, we focus on nutritional supplementation strategies that might improve myocardial performance and, as a consequence, decrease mortality and morbidity in these patients.

Recent findings: The available data suggest that micronutrient and macronutrient supplementation may play a role in improving the myocardial metabolic abnormalities noted in heart failure. A recent trial of omega-3 fatty acid macronutrient supplementation showed a modest decrease in mortality and hospitalizations when used in patients with New York Heart Association class II–IV heart failure.

Summary: Recommendations for nutritional support in patients with heart failure are difficult to make due to a lack of large randomized trials. Supplementation with omega-3 fatty acids, and micronutrients such as thiamine, coenzyme Q-10 and carnitine has shown promise in several studies. Since the data is not conclusive, large trials are needed to address whether these positive findings are reproducible in a wider subset of patients. In addition, these trials should study the combination of different micronutrients and macronutrients since heart failure patients are rarely deficient in just one micronutrient or macronutrient.

Department of Medicine, Center for Cardiovascular Quality and Outcomes, Northwestern University, Chicago, Illinois, USA

Correspondence to Mihai Gheorghiade, MD, FACC, Professor of Medicine and Surgery, Associate Chief, Division of Cardiology, Associate Director, Center for Cardiovascular Quality and Outcomes, Northwestern University Feinberg School of Medicine, 645 N. Michigan Avenue, Suite 1006, Chicago, IL 60611, USA Tel: +1 312 695 0051; fax: +1 312 695 1434; e-mail: m-gheorghiade@northwestern.edu

© 2010 Lippincott Williams & Wilkins, Inc.