Key result
Cachexia linked to ~49% higher all-cause mortality risk in older adults with HF.
Why the study?
Cachexia substantially impacts heart failure prognosis, but there is no standard diagnostic method.
Does cachexia evaluated by multi-assessment impact all-cause mortality in older adults with heart failure?
Cohort (n=1,306)
Yes
Does cachexia evaluated by multi-assessment impact all-cause mortality in older adults with heart failure?
Hazard Ratio: 1.494 (95% CI 1.173–1.903)
p-value: p=0.001
Cachexia, diagnosed via multimodal assessment, is present in over a third of older hospitalized heart failure patients and independently predicts higher all-cause mortality.
Cachexia by Evans criteria associates with higher mortality in older HF patients; supports multimodal assessment over weight loss alone for risk stratification.
BACKGROUND: Cachexia substantially impacts the prognosis of patients with heart failure (HF); however, there is no standard method for cachexia diagnosis. This study aimed to investigate the association of Evans's criteria, consisting of multiple assessments, with the prognosis of HF in older adults. METHODS: This study is a secondary analysis of the data from the FRAGILE-HF study, a prospective multicentre cohort study that enrolled consecutive hospitalized patients aged ≥65 years with HF. Patients were divided into two groups: the cachexia and non-cachexia groups. Cachexia was defined according to Evans's criteria by assessing weight loss, muscle weakness, fatigue, anorexia, a decreased fat-free mass index and an abnormal biochemical profile. The primary outcome was all-cause mortality, as assessed in the survival analysis. RESULTS: Cachexia was present in 35.5% of the 1306 enrolled patients (median age [inter-quartile range], 81 [74-86] years; 57.0% male); 59.6%, 73.2%, 15.6%, 71.0%, 44.9% and 64.6% had weight loss, decreased muscle strength, a low fat-free mass index, abnormal biochemistry, anorexia and fatigue, respectively. All-cause mortality occurred in 270 patients (21.0%) over 2 years. The cachexia group (hazard ratio [HR], 1.494; 95% confidence interval [CI], 1.173-1.903; P = 0.001) had a higher mortality risk than the non-cachexia group after adjusting for the severity of HF. Cardiovascular and non-cardiovascular deaths occurred in 148 (11.3%) and 122 patients (9.3%), respectively. The adjusted HRs for cachexia in cardiovascular mortality and non-cardiovascular mortality were 1.456 (95% CI, 1.048-2.023; P = 0.025) and 1.561 (95% CI, 1.086-2.243; P = 0.017), respectively. Among the cachexia diagnostic criteria, decreased muscle strength (HR, 1.514; 95% CI, 1.095-2.093; P = 0.012) and low fat-free mass index (HR, 1.424; 95% CI, 1.052-1.926; P = 0.022) were significantly associated with high all-cause mortality, but there was no significant association between weight loss alone (HR, 1.147; 95% CI, 0.895-1.471; P = 0.277) and all-cause mortality. CONCLUSIONS: Cachexia evaluated by multi-assessment was present in one third of older adults with HF and was associated with a worse prognosis. A multimodal assessment of cachexia may be helpful for risk stratification in older patients with HF.
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Maekawa et al. (2023) conducted a cohort in Heart failure (n=1,306). Cachexia vs. Non-cachexia was evaluated on All-cause mortality (HR 1.494, 95% CI 1.173-1.903, p=0.001). Cachexia evaluated by multi-assessment was associated with a higher risk of all-cause mortality in older adults with heart failure (HR 1.494; 95% CI 1.173-1.903; P=0.001).
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