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Heart Failure

HF: Summary of Conclusion Statements


Below is a summary of the conclusion statements and grades for the research questions from the Academy of Nutrition and Dietetics Heart Failure (2017) Systematic Review. Grades are assigned based on the strength of the evidence. To see a description of the Academy Grading  (Grade I, Grade II, Grade III, Grade IV, and Grade V), click here. To access the systematic review evidence summaries, summary tables and search plans, please use the links on the left.
 

Sodium and Fluid (2016)

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), research reported an increased risk of death or deterioration associated with frequent consumption of salty foods or increased ratio of fluids to cardiac index. Research is needed regarding the effect of sodium or fluid intake on re-admissions rate and length of stay in patients with advanced heart failure.

Grade: III


Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on quality of life, signs and symptoms?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), research reported that patients who consumed salty foods more frequently were more likely to be symptomatic, as indicated by NYHA functional class IV. Research is needed regarding the effect of sodium or fluid intake on quality of life in patients with advanced heart failure.

Grade: III
 

Question:  In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on renal function labs and clinical labs?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), research reported that hyponatremia (less than 130mg per dL) was associated with fluid intake of over two liters per day. Research is needed regarding the effect of sodium or fluid intake on BUN, creatinine and BNP in patients with advanced heart failure.

Grade: III

 

Question: n patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), what is the effect of sodium or fluid intake on renal function labs and clinical labs?

Conclusion: In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), research reported that among subjects receiving one liter of fluid per day, those consuming 2,800mg of sodium per day had significantly reduced BUN, creatinine and BNP levels than those consuming 1,800mg of sodium per day. In addition, subjects consuming 2,800mg of sodium per day had serum sodium levels that were increased and maintained within normal limits, whereas subjects consuming 1,800mg of sodium per day had a gradual reduction in serum sodium to below normal limits. Further research is needed regarding the effect of sodium or fluid intake on renal function and clinical labs.

Grade: III


Question: In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), what is the effect of sodium or fluid intake on quality measures (readmissions rate, length of stay, mortality)?

Conclusion: In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), research reported that among subjects receiving one liter of fluid per day, those consuming 2,800mg sodium per day had significantly reduced re-admissions rate, length of stay and mortality rate than those consuming 1,800mg sodium per day. However, among subjects receiving 2.0 liters to 2.4 liters of fluid per day, subjects consuming 2,800mg of sodium per day or more had significantly higher mortality rates than subjects consuming 1,900mg sodium per day or less and no patient death was observed in the middle tertile of 2,000mg to 2,700mg of sodium per day. Further research is needed regarding the effect of sodium or fluid intake on quality measures.

Grade: III

 

Question: In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), what is the effect of sodium or fluid intake on quality measures (readmissions rate, length of stay, mortality)?

Conclusion: In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), research reported that among subjects receiving one liter of fluid per day, those consuming 2,800mg sodium per day had significantly reduced re-admissions rate, length of stay and mortality rate than those consuming 1,800mg sodium per day. However, among subjects receiving 2.0 liters to 2.4 liters of fluid per day, subjects consuming 2,800mg of sodium per day or more had significantly higher mortality rates than subjects consuming 1,900mg sodium per day or less and no patient death was observed in the middle tertile of 2,000mg to 2,700mg of sodium per day. Further research is needed regarding the effect of sodium or fluid intake on quality measures.

Grade: III

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Energy (2017)

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is their measured resting metabolic rate (RMR)?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), measured resting metabolic rate (RMR) ranged from 22kcal per kg actual body weight in normally nourished patients to 24kcal per kg actual body weight in malnourished patients. Research is needed regarding measured resting metabolic rate in patients with heart failure.

Grade: III

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is their measured resting metabolic rate (RMR)?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on their measured resting metabolic rate.

Grade: V

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Protein (2017)

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the relationship between protein intake and nitrogen balance?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C) that are either normally nourished or malnourished, reported protein intakes ranging from 1.1g to 1.4g per kg of actual body weight per day resulted in positive nitrogen balance, while protein intakes ranging from 1.0g to 1.1g per kg of actual body weight per day resulted in negative nitrogen balance. Research is needed regarding the relationship between protein intake and nitrogen balance in patients with heart failure.

Grade: II


Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the relationship between protein intake and nitrogen balance?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the relationship between protein intake and nitrogen balance.

Grade: V

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Medical Nutrition Therapy (2016)

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of medical nutrition therapy by a registered dietitian nutritionist on renal function labs and clinical labs?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), research reported that despite a significant decrease in sodium intake in the Dietitian Education Group (who received two 30- to 45-minute individualized nutrition-counseling appointments with a registered dietitian, four to six weeks apart) compared to usual care (who received only a self-help educational package), serum sodium levels were maintained within normal range before and after the trial in both groups. Research is needed regarding the effect of medical nutrition therapy on renal function labs and clinical labs in patients with heart failure.

Grade: III

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of medical nutrition therapy by a registered dietitian nutritionist on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), there were no studies identified that reported on the effect of medical nutrition therapy by a registered dietitian nutritionist on quality measures.

Grade: V

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of medical nutrition therapy by a registered dietitian nutritionist on quality of life, signs and symptoms?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), research reported that despite the intensive intervention provided in the Dietitian Education Groups (who received two 30- to 60-minute individualized nutrition-counseling appointments with a registered dietitian, four to six weeks apart), compared to usual care (who received only a self-help educational package or an initial meeting with the nutritionist to undergo anthropometric evaluation, quality of life and nutritional knowledge questionnaires, and 24-hour dietary recall), there were no significant differences in quality of life or body weight. Research is needed regarding the effect of medical nutrition therapy on quality of life, signs and symptoms.

Grade: III

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of medical nutrition therapy by a registered dietitian nutritionist on quality of life, signs and symptoms?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), research reported that subjects in the Multi-Disciplinary Intervention Group (who received four individualized educational sessions from a registered dietitian nutritionist, as well as individualized dietary counselling interventions depending on the patient's body mass index and family's lifestyle and nutrition, and additional follow-up visits via telephone as often as every two weeks) had increased exercise tolerance, higher physical component scores on quality of life measures and decreased anxiety, compared to control subjects, who only received standardized recommendations (to stay on a healthy diet, to target the normal BMI ranges, to improve physical fitness by exercising on a routine basis and to seek psychosocial support if needed). In addition, while intervention subjects maintained their weight, control subjects gained significantly more weight after 18 months.

Grade: III

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of medical nutrition therapy by a registered dietitian nutritionist on renal function labs and clinical labs?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of medical nutrition therapy by a registered dietitian nutritionist on renal function labs and clinical labs.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of medical nutrition therapy by a registered dietitian nutritionist on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of medical nutrition therapy by a registered dietitian nutritionist on quality measures.

Grade: V

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Nutrient Intake and Supplementation

Coenzyme Q10 Supplementation

Question: In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), what is the effect of Coenzyme Q10 supplementation on quality of life, signs and symptoms?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), research reported mixed results regarding the effect of Coenzyme Q10 supplementation on quality of life, signs and symptoms. One study reported that the group receiving 150mg per day of oral Coenzyme Q10 had a significant improvement of 0.5 units in NYHA functional class after three months compared to the placebo group, which had no significant change. One study reported that 75% of study subjects reported no change in symptoms. However, due to the interactions between Coenzyme Q10 and some common heart-failure medications (warfarin, statins and beta-blockers), it is unclear whether this dose and duration of Coenzyme Q10 would be appropriate for patients with heart failure. Research is needed regarding the effect of Coenzyme Q10 supplementation on quality of life in patients with heart failure.

Grade: III

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of Coenzyme Q10 supplementation on quality measures (re-admissions rate, length of stay, mortality)?

Coclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), research reported no hospital admissions or deaths during the three-month intervention period within or between groups receiving either 150mg per day of oral Coenzyme Q10 or placebo. However, due to the interactions between Coenzyme Q10 and some common heart-failure medications (warfarin, statins and beta-blockers), it is unclear whether this dose and duration of Coenzyme Q10 would be appropriate for patients with heart failure. Research is needed regarding the effect of Coenzyme Q10 supplementation on quality measures in patients with heart failure.

Grade: III

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of Coenzyme Q10 supplementation on renal function labs and clinical labs?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), research reported no significant differences in creatinine levels after three months within or between groups receiving either 150mg per day of oral Coenzyme Q10 or placebo. Research is needed regarding the effect of Coenzyme Q10 supplementation on BUN, BNP and serum sodium in patients with heart failure.

Grade: III

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of Coenzyme Q10 supplementation on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of Coenzyme Q10 supplementation on quality measures.

Grade: V

 

Question:  In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of Coenzyme Q10 supplementation on quality of life, signs and symptoms?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), research reported that patients with end-stage heart failure awaiting cardiac transplantation receiving 60mg per U per day of Ultrasome-CoQ10 for three months had improved quality of life and significant decreases in frequency of nocturia, severity of fatigue, severity in dyspnea and NYHA functional classification, compared to those receiving placebo. However, due to the interactions between Coenzyme Q10 and some common heart-failure medications (warfarin, statins and beta-blockers), it is unclear whether this dose and duration of Coenzyme Q10 would be appropriate for patients with advanced heart failure. Further research is needed regarding the effect of Coenzyme Q10 supplementation on quality of life, signs and symptoms.

Grade: III

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of Coenzyme Q10 supplementation on renal function labs and clinical labs?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of Coenzyme Q10 supplementation on renal function labs and clinical labs.

Grade:  V

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Iron Supplementation

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of iron supplementation on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), there were no studies identified that reported on the effect of iron supplementation on quality measures.

Grade: V


Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of iron supplementation on quality of life, signs and symptoms?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), there were no studies identified that reported on the effect of iron supplementation on quality of life, signs and symptoms.

Grade: V

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of iron supplementation on renal function labs and clinical labs?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), there were no studies identified that reported on the effect of iron supplementation on renal function labs and clinical labs.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of iron supplementation on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of iron supplementation on quality measures.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of iron supplementation on quality of life, signs and symptoms?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of iron supplementation on quality of life, signs and symptoms.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of iron supplementation on renal function labs and clinical labs?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of iron supplementation on renal function labs and clinical labs.

Grade: V

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Omega-3 Fatty Acid Supplementation

Question: In patients with heart failure (NYHA Classes I - IV/AHA Stages B and C), what is the effect of omega-3 fatty acid supplementation on quality of life, signs & symptoms?

Conclusion: In patients with heart failure (NYHA Classes I - IV/AHA Stages B and C), research reported that the group receiving 2 g/day of omega-3 polyunsaturated fatty acids for one year had a significant decrease in NYHA functional class compared to an increase in the placebo group. However, since omega 3 fatty acid supplementation may increase the effects of blood thinning agents such as warfarin, aspirin, clopedigrel, and vitamin E, it is unclear whether this dose and duration of omega-3 fatty acids would be appropriate for patients with heart failure. Research is needed regarding the effect of omega-3 fatty acid supplementation on quality of life in patients with heart failure.

Grade: III

 

Question: In patients with heart failure (NYHA Classes I - IV/AHA Stages B and C), what is the effect of omega-3 fatty acid supplementation on renal function labs and clinical labs?

Conclusion: In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), research reported that omega-3 fatty acid supplementation, at the level of 2 g/day for three to six months, resulted in significant decreases in BNP levels. However, since omega 3 fatty acid supplementation may increase the effects of blood thinning agents such as warfarin, aspirin, clopedigrel, and vitamin E, it is unclear whether this dose and duration of omega-3 fatty acids would be appropriate for patients with heart failure. Research is needed regarding the effect of omega-3 fatty acid supplementation on BUN, creatinine and serum sodium in patients with heart failure.

Grade: III

 

Question: In patients with heart failure (NYHA Classes I to IV/AHA Stages B and C), what is the effect of omega-3 fatty acid supplementation on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with heart failure (NYHA Classes I to IV/AHA Stages B and C), research reported that omega-3 fatty acid supplementation had no significant effect on mortality rates, but the effect of 2g per day for six months to one year showed mixed results on hospitalization rates. However, since omega 3 fatty acid supplementation may increase the effects of blood-thinning agents such as warfarin, aspirin, clopedigrel and vitamin E, it is unclear whether this dose and duration of omega-3 fatty acids would be appropriate for patients with heart failure. Research is needed regarding the effect of omega-3 fatty acid supplementation on length of stay in patients with heart failure.

 Grade: III

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of omega-3 fatty acid supplementation on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of omega-3 fatty acid supplementation on quality measures.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of omega-3 fatty acid supplementation on quality of life, signs and symptoms?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of omega-3 fatty acid supplementation on quality of life, signs and symptoms.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of omega-3 fatty acid supplementation on renal function labs and clinical labs?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of omega-3 fatty acid supplementation on renal function labs and clinical labs.

Grade: V

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Thiamin Supplementation

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of thiamin supplementation on quality measures (readmissions rate, length of stay, mortality)?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), there were no studies identified that reported on the effect of thiamin supplementation on quality measures.

Grade: V

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of thiamin supplementation on quality of life, signs and symptoms?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), there were no studies identified that reported on the effect of thiamin supplementation on quality of life, signs and symptoms.

Grade: V

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of thiamin supplementation on renal function labs and clinical labs?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), there were no studies identified that reported on the effect of thiamin supplementation on renal function labs and clinical labs.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of thiamin supplementation on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of thiamin supplementation on quality measures.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of thiamin supplementation on quality of life, signs and symptoms?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of thiamin supplementation on quality of life, signs and symptoms.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of thiamin supplementation on renal function labs and clinical labs?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of thiamin supplementation on renal function labs and clinical labs.

Grade: V

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Vitamin D Supplementation

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of vitamin D supplementation on quality measures (re-admissions rate, length of stay, mortality)?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), research reported that among patients randomized to either the intervention group receiving 2,000 IU oral vitamin D3 daily for six weeks or the control group, the two adverse events that occurred during the course of the study (one death and one hospitalization) were not associated with the vitamin D supplementation. However, due to the interactions between vitamin D and some common medications (oral corticosteroids, thyroxin, anti-epileptics, tetracyclines and quinolones), it is unclear whether this dose and duration of vitamin D would be appropriate for patients with heart failure. Research is needed regarding the effect of vitamin D supplementation on quality measures in patients with heart failure.

Grade: III

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of vitamin D supplementation on quality of life, signs and symptoms?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), there were no studies identified that reported on the effect of vitamin D supplementation on quality of life, signs and symptoms.

Grade: V

 

Question: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of vitamin D supplementation on renal function labs and clinical labs?

Conclusion: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), research reported no significant differences in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels after six weeks within or between groups receiving either 2,000 IU oral vitamin D3 daily or no supplementation. Research is needed regarding the effect of vitamin D supplementation on renal function labs and clinical labs in patients with heart failure.

Grade: III

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of vitamin D supplementation on quality measures (readmissions rate, length of stay, mortality)?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of vitamin D supplementation on quality measures.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of vitamin D supplementation on quality of life, signs and symptoms?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of vitamin D supplementation on quality of life, signs and symptoms.

Grade: V

 

Question: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of vitamin D supplementation on renal function labs and clinical labs?

Conclusion: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), there were no studies identified that reported on the effect of vitamin D supplementation on renal function labs and clinical labs.

Grade: V