411Mini nutritional assessment short form tool for nurse quick screening of nutritional status in an outpatient heart failure unit

Abstract

Background: Nutritional status is an important prognostic factor in patients with heart failure (HF). Malnutrition, independently of the used definition, has been shown to carry worse prognosis above and beyond body mass index in such patients. In a pilot study we observed that the Mini Nutritional Assessment Short Form tool (MNA-SF) was the best approach for the screening of nutritional status in HF outpatients over other tools such as the Malnutrition Universal Screening Tool (MUST) or the Malnutrition Screening Tool (MST). Purpose: To implement the MNA-SF screening tool in a routine way in a multidisciplinary HF Unit in order to catch those patients with malnutrition or at risk of malnutrition for further evaluation and management by a nutritionist when appropriate. Methods: The MNA-SF screening tool was introduced in October 2016 in the global nurse evaluation of patients and scheduled to be repeated every 6 months. The scoring ranges from 0 to 14, being considered 0 to7 as malnutrition status, 8 to 11 as being in risk of malnutrition and 12 to 14 as normal nutritional status. Results: A total of 809 assessments have been performed until November 2017 in 557 patients (mean age 69±11.6 years, 70.5% men, body mass index 28.2±4.7, LVEF 45%±13, NYHA class I 6.1%, II 82.6%, and III 11.3%). At first evaluation 15 patients (2.7%) fulfilled the criteria of malnutrition, 88 (15.8%) where at risk of malnutrition and 454 (81.5%) were considered to have normal nutritional status. 252 patients were reassessed at 6.8±1.7 months. Out of the 38 reassessed patients who had malnutrition or were at risk of malnutrition at first evaluation, only 1 fulfilled the criteria of malnutrition while 14 remained at risk of malnutrition. On the other hand, of the 214 patients with normal nutritional status at first evaluation 15 evolved to at risk of malnutrition and 1 to malnutrition. Thus, of the 252 reassessed patients only 2 (0.8%) fulfilled the criteria of malnutrition and 29 (11.5%) were at risk of malnutrition. Conclusions: The implementation of the MNA-SF as a routine screening tool in a multidisciplinary HF Unit allowed detecting malnutrition and risk of malnutrition in almost one every five ambulatory patients. Malnutrition and risk of malnutrition decreased in reassessed patients at 6 months.