MALNUTRITON AND MORTALITY IN FRAIL AND NON-FRAIL OLDER ADULTS UNDERGOING INTERVENTIONS FOR PERIPHERAL ARTERIAL DISEASE
CCC ePoster Library. Mancini R. 10/26/19; 280555; 320
Rita Mancini
Rita Mancini
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Abstract
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BACKGROUND: Older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. This study sought to determine the association between preprocedural nutritional status and all-cause mortality.

METHODS AND RESULTS: This was a post-hoc analysis of the Frailty Assessment In Lower Extremity arterial Disease (FRAILED) prospective cohort including 2 centers recruiting patients between October 1, 2015 and August 1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled. The Mini Nutritional Assessment (MNA)-Short Form was assessed by trained observers preprocedure, with scores ≤7 of 14 considered malnourished and scores 8 to 11 of 14 considered at risk for malnutrition. The modified Essential Frailty Toolset (mEFT) was simultaneously assessed to measure frailty, with scores ≥3 of 5 considered frail. The primary endpoint was all-cause mortality at 12 months after the procedure. Multivariable logistic regression was used to adjust for potential confounders. There were 148 subjects with 39.2% females, a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. In the cohort, 59 (40%) had claudication and 89 (60%) had chronic limb threatening ischemia (CLTI) with 98 (66%) undergoing endovascular revascularization and 50 (34%) undergoing open or hybrid revascularization. Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12-months. Mini Nutritional Assessment-Short Form scores were modestly correlated with the mEFT scores (Pearson's R=-0.48, P < 0.001). Patients with malnourishment or at risk of malnourishment had 2.5-fold higher crude 1-year mortality compared with those with normal nutritional status. In frail patients with mEFT scores ≥3 (41%), malnutrition was associated with all-cause mortality (adjusted OR: 2.08 per point decrease in MNA scores; 95% CI: 1.03 to 4.35); whereas in nonfrail patients with mEFT scores < 3 (59%), MNA scores had no effect on mortality (adjusted OR: 1.05; 95% CI: 0.56 to 2.00).

CONCLUSION: Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals.
BACKGROUND: Older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. This study sought to determine the association between preprocedural nutritional status and all-cause mortality.

METHODS AND RESULTS: This was a post-hoc analysis of the Frailty Assessment In Lower Extremity arterial Disease (FRAILED) prospective cohort including 2 centers recruiting patients between October 1, 2015 and August 1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled. The Mini Nutritional Assessment (MNA)-Short Form was assessed by trained observers preprocedure, with scores ≤7 of 14 considered malnourished and scores 8 to 11 of 14 considered at risk for malnutrition. The modified Essential Frailty Toolset (mEFT) was simultaneously assessed to measure frailty, with scores ≥3 of 5 considered frail. The primary endpoint was all-cause mortality at 12 months after the procedure. Multivariable logistic regression was used to adjust for potential confounders. There were 148 subjects with 39.2% females, a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. In the cohort, 59 (40%) had claudication and 89 (60%) had chronic limb threatening ischemia (CLTI) with 98 (66%) undergoing endovascular revascularization and 50 (34%) undergoing open or hybrid revascularization. Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12-months. Mini Nutritional Assessment-Short Form scores were modestly correlated with the mEFT scores (Pearson's R=-0.48, P < 0.001). Patients with malnourishment or at risk of malnourishment had 2.5-fold higher crude 1-year mortality compared with those with normal nutritional status. In frail patients with mEFT scores ≥3 (41%), malnutrition was associated with all-cause mortality (adjusted OR: 2.08 per point decrease in MNA scores; 95% CI: 1.03 to 4.35); whereas in nonfrail patients with mEFT scores < 3 (59%), MNA scores had no effect on mortality (adjusted OR: 1.05; 95% CI: 0.56 to 2.00).

CONCLUSION: Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals.
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