The association between osteosarcopenia and the risk of heart failure in patients with atrial fibrillation: a prospective cohort study from UK biobank

Background Osteosarcopenia (OS), characterized by low muscle mass and bone density, is linked to cardiovascular disease. Atrial fibrillation (AF), a major cardiovascular condition, is strongly associated with heart failure (HF). However, the relationship between OS and incident HF in patients with AF remains unclear. Purpose To investigate the association between OS and incident HF in patients with AF. Methods This prospective cohort study used the UK Biobank database, selecting participants with prior AF. Participants were categorized into four groups: normal (n=16,742), sarcopenia alone (n=1,982), osteoporosis alone (n=708), and OS (n=187). Incident HF over a median 4.5-year follow-up was the primary endpoint. Results A total of 19,619 participants (mean age 68.6 ± 7.0 years, 58.3% male) were analyzed. The OS group was older, had a higher proportion of females, slower walking speed, and more frequent falls in the past year, with no significant difference in baseline left ventricular systolic function. Patients with sarcopenia or OS had higher rates of comorbidities, including hypertension, diabetes, and dyslipidemia. Sarcopenia and osteoporosis were independently associated with incident HF (adjusted hazard ratio [aHR] 1.25, 95% confidence interval [CI] 1.09–1.44; and aHR 1.59, [95% CI 1.13–2.25], respectively). OS was significantly associated with a higher risk of incident HF than the normal group (aHR 2.03, 95% CI 1.25–3.29). Conclusion OS was significantly associated with an increased risk of incident HF in patients with AF. Screening and appropriate management of OS in AF patients could help mitigate the risk and potentially reduce healthcare costs.