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Aims <p>Malnutrition is an under-recognized prognostic risk marker in patients hospitalized with heart failure (HF). We aimed to quantify the burden of documented malnutrition among HF hospitalizations in the United States and evaluate its independent associations with in-hospital mortality, complications, resource utilization, and discharge disposition across a six-year period.</p> Methods <p>We conducted a retrospective cohort study using the National Inpatient Sample (2017–2022) to identify adult hospitalizations with HF as the principal discharge diagnosis. Malnutrition was identified from secondary diagnosis fields using ICD-10-CM codes E40-E46. Survey-weighted multivariable logistic and linear regression models, adjusted for demographics, comorbidities, and hospital characteristics, were used to evaluate outcomes. Propensity score matching was performed as a sensitivity analysis.</p> Results <p>Among 6,325,668 HF hospitalizations, 339,685 (5.36%) had documented malnutrition. Malnourished patients were older (mean age 75.2 vs. 71.3 years), had higher comorbidity burden, and higher rates of palliative care involvement (14% vs. 5%) and DNR/DNI orders (27% vs. 14%). After multivariable adjustment, malnutrition was independently associated with increased in-hospital mortality (aOR 2.82, 95% CI 2.73–2.92, <i>p</i> &lt; 0.001), acute kidney injury (aOR 1.45), sepsis (aOR 4.29), and cardiogenic shock (aOR 1.57). Malnutrition was also associated with longer length of stay (+ 3.87 days) and higher total hospital charges (+$59,962). Only 27% of malnourished patients were discharged home versus 45% of non-malnourished patients. Coded malnutrition prevalence rose gradually from 5.09% in 2017 to 5.67% in 2022.</p> Conclusions <p>Malnutrition affects approximately 1 in 20 HF hospitalizations and is a strong independent risk marker of in-hospital mortality, complications, prolonged hospitalization, higher charges, and non-home discharge. These findings underscore the need for routine nutritional screening and targeted interventions in hospitalized HF patients.</p>

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Malnutrition as a critical predictor of in-hospital outcomes and resource utilization in heart failure: a 6-year nationwide analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月21日

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  • Najam Gohar,
  • Faizan Ahmed,
  • Haziq Ahmed,
  • Muhammad Taha Altaf,
  • Omama Asim,
  • Sulman Ismail,
  • Muhammad Waleed Anjum Butt,
  • Khadija Naeem,
  • Hammad Ismail,
  • Faseeh Haider,
  • Ramsha Ali,
  • Madeeha Shafqat,
  • Fenilkumar Kotadiya,
  • Haider Hussain Shah,
  • Kainat Aman,
  • Mohamed Bakr,
  • Swapnil Patel,
  • Mohammad Hossain,
  • Fawaz Alenezi

摘要

Aims

Malnutrition is an under-recognized prognostic risk marker in patients hospitalized with heart failure (HF). We aimed to quantify the burden of documented malnutrition among HF hospitalizations in the United States and evaluate its independent associations with in-hospital mortality, complications, resource utilization, and discharge disposition across a six-year period.

Methods

We conducted a retrospective cohort study using the National Inpatient Sample (2017–2022) to identify adult hospitalizations with HF as the principal discharge diagnosis. Malnutrition was identified from secondary diagnosis fields using ICD-10-CM codes E40-E46. Survey-weighted multivariable logistic and linear regression models, adjusted for demographics, comorbidities, and hospital characteristics, were used to evaluate outcomes. Propensity score matching was performed as a sensitivity analysis.

Results

Among 6,325,668 HF hospitalizations, 339,685 (5.36%) had documented malnutrition. Malnourished patients were older (mean age 75.2 vs. 71.3 years), had higher comorbidity burden, and higher rates of palliative care involvement (14% vs. 5%) and DNR/DNI orders (27% vs. 14%). After multivariable adjustment, malnutrition was independently associated with increased in-hospital mortality (aOR 2.82, 95% CI 2.73–2.92, p < 0.001), acute kidney injury (aOR 1.45), sepsis (aOR 4.29), and cardiogenic shock (aOR 1.57). Malnutrition was also associated with longer length of stay (+ 3.87 days) and higher total hospital charges (+$59,962). Only 27% of malnourished patients were discharged home versus 45% of non-malnourished patients. Coded malnutrition prevalence rose gradually from 5.09% in 2017 to 5.67% in 2022.

Conclusions

Malnutrition affects approximately 1 in 20 HF hospitalizations and is a strong independent risk marker of in-hospital mortality, complications, prolonged hospitalization, higher charges, and non-home discharge. These findings underscore the need for routine nutritional screening and targeted interventions in hospitalized HF patients.