Although older hospitalized patients with heart failure (HF) have a high prevalence of cachexia and sarcopenia, a study published in International Journal of Cardiology found that overlap of the 2 conditions is not as common.
The occurrence of cachexia and sarcopenia in HF is associated with poorer outcomes and quality of life. To date there have been no large-scale studies evaluating the prevalence and overlap of the 2 conditions in HF.
This was a substudy of the FRAGILE-HF trial, a prospective, observational study conducted at 15 hospitals in Japan between 2016 and 2020. Inpatients (N=905) with HF were assessed for sarcopenia and cachexia by trained personnel, defined using the Asian Working Group for Sarcopenia (AWGS) criteria and as described by Evans et al, respectively. The primary endpoint of this study was all-cause mortality risk on the basis of cachexia and sarcopenia comorbidities.
The patients had neither cachexia or sarcopenia (n=504), cachexia alone (n=196) sarcopenia alone (n=105), or both cachexia and sarcopenia (n=100). The patient groups had median ages of 79 to 82 years, 49.0% to 74.3% were men, they had mean BMIs of 18.1 to 23.1, body fat mass of 22.6% to 28.5%, and median skeletal muscle indices of 5.98 to 7.57.
In general, sarcopenia associated with older age, male gender, increased C-reactive protein levels, and decreased left ventricular ejection fraction, whereas cachexia associated with atrial fibrillation and decreased hemoglobin and serum albumin levels. Patients who had co-occurring cachexia and sarcopenia had the lowest body fat percentage and BMI.
During the 2-year follow-up, 17.5% of patients died from cardiovascular (n=124) or noncardiovascular (n=34) causes. The patients with co-occurring cachexia and sarcopenia had higher mortality rates than the other groups (P <.001).
In the final model, co-occurring cachexia and sarcopenia associated with increased risk of all-cause mortality (adjusted hazard ratio [aHR], 2.78; 95% CI, 1.80-4.29; P <.001) as well as the composite outcome of mortality and rehospitalization for HF (aHR, 1.45; 95% CI, 1.01-2.09; P =.046) compared with having neither cachexia nor sarcopenia.
Of note, all-cause mortality risk was not associated with either cachexia (hazard ratio [HR], 1.45; 95% CI, 0.96-2.18; P =.078) or sarcopenia (HR, 1.56; 95% CI, 0.94-2.57; P =.083) alone in the unadjusted models.
This study may have been limited as cachexia and sarcopenia evaluations occurred only once during index admission.
“Sarcopenia and cachexia are prevalent among older hospitalized patients; however, the overlap between the 2 is not as prominent as previously expected,” wrote the study authors.
Disclosures: This research was supported by Novartis Pharma. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Fujimoto Y, Maeda D, Kagiyama N, et al. Prevalence and prognostic impact of the coexistence of cachexia and sarcopenia in older patients with heart failure. Int J Cardiol. Published online March 17, 2023. doi:10.1016/j.ijcard.2023.03.035