The American Heart Association has released its first scientific statement on undernutrition in hospitalized patients with acute cardiovascular disease, outlining recommendations for screening, diagnosis and treatment of malnutrition and cachexia.
The statement, published Feb. 24 in Circulation, said 20% to 60% of patients hospitalized with acute cardiovascular disease are malnourished, though the condition often goes undiagnosed and untreated, according to a June 22 Cleveland Clinic news release. Evidence suggests inadequate nutritional intervention can contribute to worse physical function and higher mortality, particularly among older adults with cardiovascular disease.
Among its recommendations, the AHA called for use of validated screening tools to identify at-risk patients and initiation of enteral nutrition within 24 to 48 hours of admission for most cardiac ICU patients, unless they are hemodynamically unstable.
“We felt strongly about developing this statement because so many hospitalized cardiovascular patients meet the criteria for malnutrition but it is often unrecognized,” Amanda Vest, MD, section head of heart failure and transplant cardiology at Cleveland Clinic and chair of the writing group, said in the statement. “Screening in the hospital setting is key, and involving registered dietitian nutritionists is critical to optimize care and improve outcomes.”
The statement also advises clinicians to reconsider routine fasting before cardiac catheterization and electronic device implantation procedures. For cardiac surgery patients, the group recommended preoperative nutrition assessment, early postoperative enteral feeding and consideration of parenteral feeding if enteral nutrition is not feasible within seven days.
The guidance emphasizes the role of registered dietitian nutritionists in cardiovascular care and provides protein intake targets of 1 to 1.2 grams per day for patients with cardiac cachexia, 1.2 to 2.0 grams per day for critically ill patients and 1.5 grams per day for patients undergoing sternotomy.
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