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.
AbstractBackgroundNo 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.
MethodsThis 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.
ResultsCachexia 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.
ConclusionsCachexia 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.
KeywordsHeart failure
cachexia
Sarcopenia
Prognosis
Older patients
AbbreviationsAWGSAsian Working Group for Sarcopenia
BNPbrain natriuretic peptide
LVEFleft ventricular ejection fraction
MAGGICMeta-analysis Global Group in Chronic Heart Failure
MUACmid-upper arm circumference
MUAMCmid-upper arm muscle circumference
NT-pro BNPN-terminal pro BNP
NYHANew York Heart Association
SICA-HFStudies Investigating Co-morbidities Aggravating Heart Failure
SPPBShort Physical Performance Battery
TSFtriceps skinfold thickness
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