Brief Original
Does nutritional intervention maintain its prognostic benefit in the long term for malnourished patients hospitalised for heart failure?
¿Mantiene la intervención nutricional en pacientes hospitalizados por insuficiencia cardiaca desnutridos su beneficio pronóstico a largo plazo?
J.L. Bonilla-Palomasa,
, A.L. Gámez-Lópeza, J.C. Castillo-Domínguezb, M. Moreno-Condec, M.C. López-Ibáñezc, M. Anguita-Sánchezb
Corresponding author
a Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain
b Unidad de Gestión Clínica de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
c Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain
Read
13
Timeswas read the article
7
Total PDF
6
Total HTML
Share statistics
array:25 [ "pii" => "S2254887417301364" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.10.006" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1447" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Clin Esp. 2018;218:58-60" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256517302588" "issn" => "00142565" "doi" => "10.1016/j.rce.2017.10.005" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1447" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Clin Esp. 2018;218:58-60" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 61 "formatos" => array:2 [ "HTML" => 37 "PDF" => 24 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Breve</span>" "titulo" => "¿Mantiene la intervención nutricional en pacientes hospitalizados por insuficiencia cardiaca desnutridos su beneficio pronóstico a largo plazo?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "58" "paginaFinal" => "60" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Does nutritional intervention maintain its prognostic benefit in the long term for malnourished patients hospitalised for heart failure?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2367 "Ancho" => 3018 "Tamanyo" => 211539 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curvas de Kaplan-Meier de los 2 grupos de pacientes (intervención y control) para los eventos del estudio.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.L. Bonilla-Palomas, A.L. Gámez-López, J.C. Castillo-Domínguez, M. Moreno-Conde, M.C. López-Ibáñez, M. Anguita-Sánchez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.L." "apellidos" => "Bonilla-Palomas" ] 1 => array:2 [ "nombre" => "A.L." "apellidos" => "Gámez-López" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Castillo-Domínguez" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Moreno-Conde" ] 4 => array:2 [ "nombre" => "M.C." "apellidos" => "López-Ibáñez" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Anguita-Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887417301364" "doi" => "10.1016/j.rceng.2017.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417301364?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517302588?idApp=WRCEE" "url" => "/00142565/0000021800000002/v1_201802240414/S0014256517302588/v1_201802240414/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887417301534" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.10.009" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1449" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Clin Esp. 2018;218:61-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "PDF" => 3 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief original</span>" "titulo" => "Mortality hospital of nonagenarian patients in Internal Medicine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "61" "paginaFinal" => "65" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad hospitalaria de pacientes nonagenarios en Medicina Interna" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Singer, A. Conde-Martel, M. Hemmersbach-Miller, J.J. Ruiz-Hernández, J. Arencibia Borrego, B. Alonso Ortiz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Singer" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Conde-Martel" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Hemmersbach-Miller" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "Ruiz-Hernández" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Arencibia Borrego" ] 5 => array:2 [ "nombre" => "B." "apellidos" => "Alonso Ortiz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517302606" "doi" => "10.1016/j.rce.2017.10.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517302606?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417301534?idApp=WRCEE" "url" => "/22548874/0000021800000002/v1_201802230423/S2254887417301534/v1_201802230423/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2254887418300018" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.12.001" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1458" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2018;218:49-57" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Proposed clinical scale for the diagnosis of acute coronary syndrome in patients with an inconclusive electrocardiogram and myocardial injury biomarkers" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "49" "paginaFinal" => "57" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Propuesta de una escala clínica para el diagnóstico de síndrome coronario agudo en pacientes con electrocardiograma y biomarcadores de lesión miocárdica no concluyentes" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1031 "Ancho" => 1585 "Tamanyo" => 104920 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flow algorithm for study patient enrollment.</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: ACS, acute coronary syndrome; ECG, electrocardiogram.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. Montero-Pérez, F.B. Quero-Espinosa, M.J. Clemente-Millán, J.A. Castro-Giménez, J. de Burgos-Marín, M.Á. Romero-Moreno" "autores" => array:6 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Montero-Pérez" ] 1 => array:2 [ "nombre" => "F.B." "apellidos" => "Quero-Espinosa" ] 2 => array:2 [ "nombre" => "M.J." "apellidos" => "Clemente-Millán" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Castro-Giménez" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "de Burgos-Marín" ] 5 => array:2 [ "nombre" => "M.Á." "apellidos" => "Romero-Moreno" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517302898" "doi" => "10.1016/j.rce.2017.12.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517302898?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300018?idApp=WRCEE" "url" => "/22548874/0000021800000002/v1_201802230423/S2254887418300018/v1_201802230423/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S2254887418300237" "issn" => "22548874" "doi" => "10.1016/j.rceng.2018.01.002" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1461" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2018;218:68-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The importance of nutritional status in heart failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "68" "paginaFinal" => "69" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La importancia del estado nutricional en la insuficiencia cardiaca" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.C. Trullàs" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J.C." "apellidos" => "Trullàs" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256518300201" "doi" => "10.1016/j.rce.2018.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518300201?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300237?idApp=WRCEE" "url" => "/22548874/0000021800000002/v1_201802230423/S2254887418300237/v1_201802230423/en/main.assets" ] ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Original</span>" "titulo" => "Does nutritional intervention maintain its prognostic benefit in the long term for malnourished patients hospitalised for heart failure?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "58" "paginaFinal" => "60" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.L. Bonilla-Palomas, A.L. Gámez-López, J.C. Castillo-Domínguez, M. Moreno-Conde, M.C. López-Ibáñez, M. Anguita-Sánchez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "J.L." "apellidos" => "Bonilla-Palomas" "email" => array:1 [ 0 => "juanl.bonilla.sspa@juntadeandalucia.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A.L." "apellidos" => "Gámez-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.C." "apellidos" => "Castillo-Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Moreno-Conde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "M.C." "apellidos" => "López-Ibáñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Anguita-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Mantiene la intervención nutricional en pacientes hospitalizados por insuficiencia cardiaca desnutridos su beneficio pronóstico a largo plazo?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2367 "Ancho" => 3018 "Tamanyo" => 202564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier curves of the 2 patient groups (intervention and control) for the study events.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Malnutrition is a common comorbidity in patients hospitalized for heart failure (HF) and represents a potent predictor of mortality, such that 2 years after the hospital discharge, malnourished patients have almost 4 times the risk of dying than patients who have a normal nutritional status.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The results of the Nutritional Intervention Program for Malnourished Patients Hospitalized for Heart Failure (PICNIC) study showed that a nutritional intervention for malnourished patients hospitalized for HF reduces the risk of all-cause death and readmission for HF during the 12 months after hospital discharge.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The objective of the present study was to assess the long-term effects of the nutritional intervention on patients included in the PICNIC study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">The design of the PICNIC study has already been published.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> Briefly, this was a multicenter clinical trial in which the malnourished patients hospitalized for HF were assigned (using a simple randomization process) to undergo (or not) an individual nutritional intervention, added to the conventional treatment for HF. The patients signed the informed consent document and participated in the study according to the protocol approved by the ethics committees of the participating centers. The diagnosis of malnutrition was established after obtaining a score of <17 points on the Mini Nutritional Assessment survey. In accordance with the protocol, the intervention was extended for 6 months and was based on 3 points: diet optimization, specific recommendations and nutritional supplements (prescribed for 12% of the patients) when the nutritional objectives were not reached with the diet. The primary endpoint was the combined event of all-cause death or readmission for HF. The analysis was performed by intention to treat. PICNIC is registered in ClinicalTrial.gov (<a href="ctgov:NCT01472237">NCT01472237</a>). In this analysis, we assessed the effects of the intervention at 2 years of follow-up.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">Between March 2012 and April 2014, a total of 120 patients were included in the study. The 2 groups were homogeneous in terms of their baseline characteristics.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> At 2 years, the combined event occurred in 47.5% of the intervention group and in 73.8% of the control group (hazard ratio, 0.45; 95% confidence interval 0.28–0.72; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Thirty-nine percent of the intervention group and 59% of the control group died (hazard ratio, 0.53; 95% confidence interval 0.31–0.89; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.017). The readmission rate for HF was also lower in the intervention group (18.6% vs. 39.3%, respectively; log-rank test, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">The results of this analysis demonstrate that the benefit of a nutritional intervention applied for 6 months in malnourished patients hospitalized for HF is maintained in the long term. It is possible that a nutritional intervention can help optimize energy intake and thereby moderate the imbalance between anabolism/catabolism, which is the result of the neurohormonal and inflammatory activation of HF itself.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Nutritional measures can also optimize the protein supply and increase protein synthesis, which is necessary for maintaining muscle mass and serum albumin concentrations. The catabolic state,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> the reduction in muscle mass<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> and hypoalbuminemia<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> are predictors of mortality in HF. Early modification of these factors could change the disease progression in malnourished patients and explain the benefit of the nutritional intervention.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary, a nutritional intervention for 6 months in malnourished patients hospitalized for HF improved the prognosis, not only immediately but also after the intervention ended. It is essential to include a nutritional state assessment in the comprehensive of patients with HF and act early when malnutrition is detected.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">The PICNIC study was funded as a Clinical Research Project in Cardiology by the Spanish Society of Cardiology.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres991059" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec954981" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres991058" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec954982" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-01" "fechaAceptado" => "2017-10-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec954981" "palabras" => array:4 [ 0 => "Heart failure" 1 => "Nutritional intervention" 2 => "Clinical trial" 3 => "Long-term events" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec954982" "palabras" => array:4 [ 0 => "Insuficiencia cardiaca" 1 => "Intervención nutricional" 2 => "Ensayo clínico" 3 => "Eventos a largo plazo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the long-term effect of nutritional intervention on malnourished, hospitalised patients with heart failure (HF).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 120 malnourished patients hospitalized for HF were randomized to undergo (or not) an individual nutritional intervention for 6 months. The primary event was the combination of all-cause death and readmission for HF. We performed an intent-to-treat analysis and assessed the effect of the intervention at 24 months.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The combined event occurred in 47.5% of the intervention group and in 73.8% of the control group (hazard ratio: 0.45; 95% confidence interval: 0.28–0.72; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001). Thirty-nine percent of the intervention group and 59% of the control group died (hazard ratio: 0.53; 95% confidence interval: 0.31–0.89; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.017).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A nutritional intervention for malnourished patients hospitalised for HF maintains its prognostic benefit in the long-term follow-up.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar el efecto a largo plazo de una intervención nutricional en pacientes hospitalizados con insuficiencia cardiaca (IC) y desnutridos.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un total de 120 pacientes hospitalizados por IC y desnutridos fueron aleatorizados a recibir o no una intervención nutricional individualizada durante 6 meses. El evento primario fue el combinado de muerte por cualquier causa o reingreso por IC. Se realizó un análisis por intención de tratar y se evaluó el efecto de la intervención a los 24 meses.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El evento combinado ocurrió en el 47,5% de los pacientes del grupo de intervención y en el 73,8% del grupo control (<span class="elsevierStyleItalic">hazard ratio</span>: 0,45; intervalo de confianza del 95%: 0,28-0,72; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001). Fallecieron el 39% en el grupo de intervención y el 59% en el grupo control (<span class="elsevierStyleItalic">hazard ratio</span>: 0,53; intervalo de confianza del 95%: 0,31-0,89; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,017).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una intervención nutricional en pacientes hospitalizados por IC que están desnutridos mantiene su beneficio pronóstico en el seguimiento a largo plazo.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bonilla-Palomas JL, Gámez-López AL, Castillo-Domínguez JC, Moreno-Conde M, López-Ibáñez MC, Anguita-Sánchez M. ¿Mantiene la intervención nutricional en pacientes hospitalizados por insuficiencia cardiaca desnutridos su beneficio pronóstico a largo plazo? Rev Clin Esp. 2018;218:58–60.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2367 "Ancho" => 3018 "Tamanyo" => 202564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier curves of the 2 patient groups (intervention and control) for the study events.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influencia de la desnutrición en la mortalidad a largo plazo de pacientes hospitalizados por insuficiencia cardiaca" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Bonilla-Palomas" 1 => "A.L. Gamez-Lopez" 2 => "M.P. Anguita-Sanchez" 3 => "J.C. Castillo-Dominguez" 4 => "D. Garcia-Fuertes" 5 => "M. Crespin-Crespin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.recesp.2011.03.009" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2011" "volumen" => "64" "paginaInicial" => "752" "paginaFinal" => "758" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21652135" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nutritional intervention in malnourished hospitalized patients with heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Bonilla-Palomas" 1 => "A.L. Gámez-López" 2 => "J.C. Castillo-Domínguez" 3 => "M. Moreno-Conde" 4 => "M. López-Ibáñez" 5 => "R. Alhambra-Expósito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arcmed.2016.11.005" "Revista" => array:6 [ "tituloSerie" => "Arch Med Res" "fecha" => "2016" "volumen" => "47" "paginaInicial" => "535" "paginaFinal" => "540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28262195" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rationale and design of PICNIC study: nutritional intervention program in hospitalized patients who are malnourished" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.A.L. Gámez-López" 1 => "J.L. Bonilla-Palomas" 2 => "M.P. Anguita-Sanchez" 3 => "M. Moreno-Conde" 4 => "C. López-Ibáñez" 5 => "R. Alhambra-Expóstico" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2013.07.013" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2014" "volumen" => "67" "paginaInicial" => "277" "paginaFinal" => "282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24774590" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurohormonal factors in the development of catabolic/anabolic imbalance and cachexia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Brink" 1 => "A. Anwar" 2 => "P. Delafontaine" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2002" "volumen" => "85" "paginaInicial" => "111" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12163215" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of mortality in chronic heart failure from peak oxygen consumption adjusted for either body weight or lean tissue" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Cicoira" 1 => "C.H. Davos" 2 => "D.P. Francis" 3 => "W. Doehner" 4 => "L. Zanolla" 5 => "L. Franceschini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2004" "volumen" => "10" "paginaInicial" => "421" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15470653" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypoalbuminemia in acute heart failure patients: causes and its impact on hospital and long-term mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Bonilla-Palomas" 1 => "A.L. Gamez-Lopez" 2 => "M. Moreno-Conde" 3 => "M.C. Lopez-Ibanez" 4 => "M. Anguita-Sanchez" 5 => "A. Gallego de la Sacristana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2014.01.016" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "350" "paginaFinal" => "358" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24486927" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021800000002/v1_201802230423/S2254887417301364/v1_201802230423/en/main.assets" "Apartado" => array:4 [ "identificador" => "1903" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief Original" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021800000002/v1_201802230423/S2254887417301364/v1_201802230423/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417301364?idApp=WRCEE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 6 | 5 | 11 |
| 2018 March | 0 | 1 | 1 |
| 2017 December | 0 | 1 | 1 |
