**3. Methods**

#### *3.1. Study Design*

This study was a secondary economic analysis of CHF patients who were part of EFFORT—a prospective, noncommercial, multicenter, randomized controlled trial. EFFORT was registered at ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT02517476 (accessed on 7 August 2015) and conducted in eight Swiss hospitals. The overall objective of the original trial was to compare medical outcomes for patients at risk of malnutrition who were randomized to (i) an intervention group (individualized nutritional support to reach energy, protein, and micronutrient goals) or (ii) a control group (receiving usual hospital food).

Individualized nutritional support included screening patients for malnutrition risk on admission; dietitian-conducted nutritional assessment for patients identified to be at risk for malnutrition; individualized nutritional care plans developed by a dietitian; and implementation of the care plan with monitoring of health outcomes during hospitalization and follow-up post-discharge [23,25].

The rationale for the initial trial, design details, and eligibility features were previously reported [25], and the primary results of the full study were recently published [23,26], as were health outcomes in the CHF patient population [24]. The present study is based on CHF inpatients only, and it represents an analysis of healthcare costs and health outcomes in EFFORT's two comparator groups—patients who were randomized to receive individualized nutritional support (intervention group) and those who received usual hospital food (control group) [24]. EFFORT included a total of 645 patients with CHF, with 234 (36%) acutely decompensated and 411 (64%) with chronic stable HF [24].
