Cachexia and outcome in patients with heart failure: analysis of 3,476,039 hospitalisations

Background Cachexia reduces exercise tolerance, quality of life and survival in patients with heart failure (HF). The International Classification of Diseases (ICD) has a specific code for cachexia but is it largely unknown whether this code is use in clinical practice. Objecitves. To analyse prevalence of cachexia in hospitalised patients with HF and their outcome. Methods We conducted an analysis of the National Hospital Health Care Statistics Database that captures all hospitalisations in Slovenia. During period 2010-2019, patients were identified using the ICD-10 discharge codes for HF and cachexia to investigate prevalence of cachexia as a discharge code, patient characteristics, length of stay and mortality. Results In total, 3,476,039 hospitalisations were screened to identify 97,352 patients with HF (77±12 years, 47% women) who were hospitalised 203,080 times. Cachexia was diagnosed in 1248 (1.3%) patients; they stayed longer in hospital than those without cachexia (16±19 vs 12±15 days, p<0.001) and more of them died (32% vs 17%, p<0.001). In patients who were discharged alive, cachexia was associated with poor survival (Figure). In Cox model of proportional hazards, adjusted for age, sex and comorbidities, cachexia predicted post-discharge mortality (hazard ratio 1.22, 95% confidence interval 1.09 - 1.38). Conclusions The national hospitalisation database analysis showed that in patients with heart failure cachexia is infrequently coded. Patients with cachexia were hospitalised longer and had higher in-hospital and post discharge mortality.