Prognostic implication of sarcopenia diagnosed by updated Asian Working Group for Sarcopenia criteria in older patients with heart failure: Utility and limitation

OBJECTIVES: The utility of the updated Asian Working Group for Sarcopenia (AWGS) criteria in diagnosing sarcopenia in older patients with heart failure (HF) remains unclear. OBJECTIVE: To analyze the prevalence and prognostic impact of sarcopenia diagnosed by the updated AWGS criteria in older patients with HF. DESIGN: Ambispective cohort study. SETTING & SUBJECTS: 534 older patients with HF from a university hospital in Japan. MEASUREMENTS: Sarcopenia was assessed using different versions of the AWGS criteria: AWGS 2014, AWGS 2019H (muscle mass relative to height squared), and AWGS 2019B (muscle mass relative to BMI). The primary endpoint was all-cause mortality at three years post-discharge. RESULTS: Of 534 patients, 42%, 57%, and 44% were diagnosed with sarcopenia according to AWGS 2014, AWGS 2019H, AWGS 2019B, respectively. Among patients without AWGS 2014-defined sarcopenia, 23% were reclassified as having sarcopenia by AWGS 2019H criteria. Forty-four percent of sarcopenic patients diagnosed by AWGS 2019H were re-classified as non-sarcopenic by AWGS 2019B, with lower fat mass and poorer nutritional status. After the multivariate Cox proportional hazard analyses, an association between all-cause death and sarcopenia remained significant for AWGS 2014 (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.01-2.37) and AWGS 2019H (HR, 1.65; 95% CI, 1.05-2.59), but not for AWGS 2019B (HR, 0.99; 95% CI, 0.64-1.51). CONCLUSION: The updated AWGS 2019H criteria detected more sarcopenic patients with HF while maintaining favorable predictive ability. The use of BMI-adjusted muscle mass reclassified underweight and malnourished patients as non-sarcopenic, limiting its impact on the mortality prediction in older patients with HF.