"Synergistic Effects of Nutritional, Cognitive, and Cardiac Rehabilitation Parameters on Prognosis in Patients with Systolic Heart Failure".

Introduction: It is well known that cardiac rehabilitation improves the prognosis of patients with heart failure (HF). However, there are few reports on the impact of cardiac rehabilitation interventions on the prognosis of patients with HF, malnutrition, and cognitive impairment. Methods: In 807 consecutive patients with HF and left ventricular ejection fraction <50%, the Functional Independence Measure (FIM) was used to assess the effectiveness of cardiac rehabilitation. Nutritional status and cognitive function were also assessed in all of the patients. The patients were followed up for 26.9 months with a primary endpoint of lethal cardiac events (CEs). Results: During the follow-up period, CEs were documented in 303 patients with HF. The group of patients with CEs had a lower serum cholinesterase (ChE) level, a lower Mini-Mental State Examination (MMSE) score, and lower motor and total FIM scores than the group of patients without CEs. In overall multivariate analysis, serum ChE level, MMSE score, and total FIM score were shown to be significant prognostic determinants. Receiver operating characteristic analyses revealed the cut-off values for serum ChE level, MMSE score, and total FIM score for identifying patients with HF at high risk. Patients with HF who had serum ChE <232U/L, an MMSE score <26, and a total FIM score <114 showed a significantly higher CE rate than the other patients. Conclusions: The results suggested that the addition of cardiac rehabilitation parameters to the nutritional and cognitive status of patients with HF is synergically useful for risk stratification in predicting prognosis.