Top Things to Know: Malnutrition & Cachexia in Inpatients with Acute Cardiac Conditions
Published: February 24, 2026
Prepared by Paul St. Laurent, DNP, RN, Vice President, Science & Medicine American Heart Association
- Malnutrition remains common yet underrecognized in patients with cardiovascular disease (CVD), particularly in critical care.
- The use of validated screening tools to identify at-risk patients, followed by assessment using standardized diagnostic criteria and timely nutrition intervention, is key to improving clinical outcomes.
- The risk of gut ischemia can be reduced by initiating enteral nutrition within 24–48 hours of CICU admission for most patients, with hypocaloric, high-protein feeds for those on low-dose vasopressors.
- The protein intake goals for patients with cardiac cachexia are 1–1.2 g/kg/day, and 1.2–2.0 g/kg/day for critically ill adults, as higher intakes have not been shown to provide additional benefit.
- Recent evidence suggests that routine fasting before elective cardiac procedures may be unnecessary and potentially detrimental to nutritional status, supporting the practice of allowing clear liquids for up to two hours and light meals up to six hours before surgery, depending on the procedure.
- Preoperative nutrition assessment, Enhanced Recovery After Surgery (ERAS) protocols, and early enteral feeding help reduce complications and support recovery, while parenteral nutrition may prevent malnutrition when enteral feeding isn't possible.
- Individualized nutrition interventions, including counseling by registered dietitian nutritionists, can reduce hospital readmissions and mortality in patients with heart failure.
- Medically tailored meals, aligned with the “Food Is Medicine” model, can improve dietary adherence and reduce cardiovascular readmissions, especially when they are culturally appropriate and accessible.
- Cardiac rehabilitation is an underused opportunity for delivering nutrition education, and embedding registered dietitian nutritionists in these programs can improve adherence to heart-healthy diets and support long-term prevention.
- Registered dietitian nutritionists are essential across the cardiovascular care continuum but remain underutilized, and greater integration and staffing are needed to meet patient needs effectively.
Citation
Vest AR, DiDomenico RJ, Lichtenstein L, Slater T, Ekpo E, Damluji AA, Bohula E, Alviar CL; on behalf of the American Heart Association Acute Car¬diac Care and General Cardiology Committee of the Council on Clinical Cardiology; and Council on Cardiovascular and Stroke Nursing. Malnutrition and cachexia in inpatients with acute cardiac conditions: a scientific statement from the American Heart Association. Circulation. Published online February 24, 2026. doi: 10.1161/CIR.0000000000001405