Malnutrition is prevalent among inpatients with acute cardiovascular conditions, with estimates ranging from 20% to 60% in hospitalized populations. Although most literature emphasizes heart failure, malnutrition also affects patients with acute coronary syndromes, arrhythmias, and valvular disease. Application of Global Leadership Initiative on Malnutrition criteria to cardiovascular patients has demonstrated prognostic relevance, linking malnutrition to reduced physical function and higher mortality risk. Nutritional management should be initiated early in the inpatient setting, especially within the cardiac intensive care unit. Enteral feeding within 48 hours of admission is preferred and is favored for cost-effectiveness relative to parenteral nutrition. Enteral nutrition has the potential to reduce mortality and shorten hospital stays when feasible. Parenteral nutrition is reserved for cases of severe gastrointestinal dysfunction or when enteral feeding is contraindicated or insufficient, such as during high vasopressor doses that impair intestinal perfusion or when nutritional targets remain unmet after the first week. Regarding protein targets in cardiogenic shock, evidence is evolving; higher protein strategies have not shown consistent benefit in recent critical care trials, indicating ongoing uncertainty in this subgroup.
Circulation, Volume 153, Issue 13 , Page e1078-e1105, March 31, 2026. Malnutrition can affect patients with various acute cardiovascular disease conditions, including acute coronary syndromes, arrhythmias, or valvular disease; however, most of the literature has focused on patients with heart failure. Malnutrition prevalence estimates range from 20% to 60% for hospitalized patients. Use of Global Leadership Initiative on Malnutrition criteria for malnutrition diagnosis for patients with cardiovascular disease has confirmed prognostic value, correlating with poorer physical function and higher mortality. Nutritional support plays a key role for inpatients, particularly in the cardiac intensive care unit, and includes initiation of feeding within 48 hours of hospitalization, preferably through enteral nutrition. Enteral nutrition is more cost-effective compared with parenteral nutrition and can decrease mortality and shorten lengths of stay. Parenteral nutrition is reserved for patients with severe gastrointestinal dysfunction or to supplement nutrition when enteral nutrition is contraindicated, for example, during high pressor doses that preclude adequate intestinal perfusion or when achieving <70% of nutritional targets after the first week. The optimal protein intake for patients with cardiogenic shock is an area of ongoing research, with higher protein approaches not appearing beneficial in recent critical care trials.