Key result
Low muscle mass plus discharge hypoalbuminemia linked to ~2-fold higher mortality in acute heart failure.
Why the study?
The combined impact of coexisting sarcopenia and hypoalbuminemia on morbidity and mortality in adults hospitalized with acute decompensated heart failure had not been investigated.
Does the coexistence of lower muscle mass and discharge hypoalbuminemia increase the risk of adverse outcomes and mortality in patients hospitalized for acute decompensated heart failure?
Cohort (n=385)
No
Does the coexistence of lower muscle mass and discharge hypoalbuminemia increase the risk of adverse outcomes and mortality in patients hospitalized for acute decompensated heart failure?
Hazard Ratio: 2.03 (95% CI 1.31–3.16)
Absolute Event Rate: 63.2% vs 37.6%
p-value: p=0.002
The coexistence of sarcopenia (estimated via CT muscle mass) and hypoalbuminemia identifies a highly vulnerable heart failure phenotype with over doubled postdischarge mortality risk.
Background Sarcopenia and hypoalbuminemia have been identified as independent predictors of increased adverse outcomes, including mortality and readmissions, in hospitalized older adults with acute decompensated heart failure (ADHF). However, the impact of coexisting sarcopenia and hypoalbuminemia on morbidity and death in adults with ADHF has not yet been investigated. We aimed to investigate the combined effects of lower muscle mass (LMM) as a surrogate for sarcopenia and hypoalbuminemia on in‐hospital and postdischarge outcomes of patients hospitalized for ADHF. Methods and Results A total of 385 patients admitted for ADHF between 2017 and 2020 at a single institution were retrospectively identified. Demographic and clinical data were collected, including serum albumin levels at admission and discharge. Skeletal muscle indices were derived from semi‐automated segmentation software analysis on axial chest computed tomography at the twelfth vertebral level. Our analysis revealed that patients who had LMM with admission hypoalbuminemia experienced increased diagnoses of infection and delirium with longer hospital length of stay and more frequent discharge to a facility. Upon discharge, 27.9% of patients had higher muscle mass without discharge hypoalbuminemia (reference group), 9.7% had LMM without discharge hypoalbuminemia, 38.4% had higher muscle mass with discharge hypoalbuminemia, and 24.0% had LMM with discharge hypoalbuminemia; mortality rates were 37.6%, 51.4%, 48.9%, and 63.2%, respectively. 1‐ and 3‐year mortality risks were highest in those with LMM and discharge hypoalbuminemia; this relationship remained significant over a median 23.6 (3.1–33.8) months follow‐up time despite multivariable adjustments (hazard ratio, 2.03 [95% CI, 1.31–3.16]; P =0.002). Conclusions Hospitalization with ADHF, LMM, and hypoalbuminemia portend heightened mortality risk.
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Mirzai et al. (2024) conducted a cohort in Acute Decompensated Heart Failure (ADHF) (n=385). Lower muscle mass (LMM) with discharge hypoalbuminemia vs. Higher muscle mass (HMM) without discharge hypoalbuminemia was evaluated on All-cause death over a median 23.6 months follow-up (HR 2.03, 95% CI 1.31-3.16, p=0.002). Coexisting lower muscle mass and discharge hypoalbuminemia increased the risk of all-cause death by over two-fold (HR 2.03) compared to higher muscle mass without discharge hypoalbuminemia in patients with acute decompensated heart failure.
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