Prevalence and prognostic impact of the coexistence of cachexia and sarcopenia in older patients with heart failure

ElsevierVolume 381, 15 June 2023, Pages 45-51International Journal of CardiologyAuthor links open overlay panel, , , , , , , , , , , , , , , , , , , …Highlights•

Sarcopenia and cachexia in older patients with heart failure were investigated.

Cachexia and sarcopenia are prevalent in the studied population.

The overlap between the two conditions is not as prominent as expected.

The presence of both cachexia and sarcopenia increases all-cause mortality.

AbstractBackground

No study with an adequate patients' number has examined the relationship/overlap between sarcopenia and cachexia. We examined the prevalence of the overlap and prognostic implications of sarcopenia and cachexia in older patients with heart failure using well-accepted definitions.

Methods

This was a post-hoc sub-analysis of the FRAGILE-HF study, a prospective, multicenter, observational study conducted at 15 hospitals in Japan. In total, 905 hospitalized older patients were classified into four groups based on the presence or absence of cachexia and/or sarcopenia, which were defined according to the Evans and Asian Working Group for Sarcopenia criteria revised in 2019, respectively. The primary endpoint was 2-year all-cause mortality.

Results

Cachexia and sarcopenia prevalence rates were 32.7% and 22.7%, respectively. Patients were classified into the non-cachexia/non-sarcopenia (55.7%), cachexia/non-sarcopenia (21.7%), non-cachexia/sarcopenia (11.6%), and cachexia/sarcopenia (11.0%) groups. During the 2-year follow-up period after discharge, 158 (17.5%) all-cause deaths (124 cardiovascular deaths [CVD] and 34 non-CVD) were observed. The cachexia/sarcopenia group had the lowest body fat mass and exhibited significantly higher mortality rates (log-rank P < 0.001). Cox proportional hazard analysis revealed that cachexia/sarcopenia was an independent prognostic factor after adjusting for known prognostic factors (versus non-cachexia/non-sarcopenia: hazard ratio, 2.78; 95% confidence interval, 1.80–4.29; P < 0.001). Neither cachexia/non-sarcopenia nor non-cachexia/sarcopenia were significantly associated with all-cause mortality compared with non-cachexia/non-sarcopenia.

Conclusions

Cachexia and sarcopenia are prevalent among older hospitalized patients with heart failure; nonetheless, the overlap is not as prominent as previously expected. The presence of cachexia and sarcopenia is a risk factor for all-cause mortality.

Keywords

Heart failure

cachexia

Sarcopenia

Prognosis

Older patients

AbbreviationsAWGS

Asian Working Group for Sarcopenia

BNP

brain natriuretic peptide

LVEF

left ventricular ejection fraction

MAGGIC

Meta-analysis Global Group in Chronic Heart Failure

MUAC

mid-upper arm circumference

MUAMC

mid-upper arm muscle circumference

NT-pro BNP

N-terminal pro BNP

NYHA

New York Heart Association

SICA-HF

Studies Investigating Co-morbidities Aggravating Heart Failure

SPPB

Short Physical Performance Battery

TSF

triceps skinfold thickness

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