What question did this study set out to answer?

This research aims to clarify the relationship between sarcopenia and outcomes in older patients with heart failure using updated diagnostic criteria.

March 30, 2026Open Access

Height- and Body Mass Index-Based Sarcopenia　― Prognostic and Functional Implications in Older Patients Hospitalized for Heart Failure ―

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=594). Intervention: H-sarcopenia (height-adjusted appendicular skeletal muscle mass) vs. No H-sarcopenia. Primary outcome: All-cause mortality (HR 1.48, 95% CI 1.035-2.117, p=0.032).

Key Result

Height-adjusted sarcopenia was independently associated with a 48% higher risk of all-cause mortality (HR 1.48) in older patients hospitalized for heart failure, whereas BMI-adjusted sarcopenia was not.

Key Points

This research aims to clarify the relationship between sarcopenia and outcomes in older patients with heart failure using updated diagnostic criteria.
Evaluated older patients hospitalized for heart failure.
Applied the 2025 AWGS criteria to assess sarcopenia.
Measured muscle strength and muscle mass based on height and BMI.
Identified a correlation between sarcopenia and poorer prognostic outcomes.
Highlighted the importance of muscle strength in managing heart failure.
Showed that updated definitions of sarcopenia may improve patient assessments.

Study Design

Type

Cohort (n=594)

Multicenter

Structured PICO

Does sarcopenia defined by height-adjusted vs BMI-adjusted appendicular skeletal muscle mass predict mortality and functional decline in older patients hospitalized for heart failure?

Population

Patients aged ≥65 years hospitalized for heart failure, median age 81.0, 41.4% female

Intervention

Sarcopenia defined by AWGS 2025 criteria (H-sarcopenia using height-adjusted appendicular skeletal muscle mass or B-sarcopenia using BMI-adjusted appendicular skeletal muscle mass)

Comparator

Patients without sarcopenia

Outcome

All-cause mortalityhard clinical

In older patients hospitalized for heart failure, height-adjusted sarcopenia is a stronger predictor of mortality, while BMI-adjusted sarcopenia better reflects physical functional impairment.

Main Result

Effect estimate: HR 1.48 (95% CI 1.035-2.117)

Absolute Event Rate: 31.2% vs 24%

p-value: p=0.032

Limitations

Single-center retrospective design introduces potential selection bias and limits causal inference.
Appendicular skeletal muscle mass was assessed using bioelectrical impedance analysis, which may be affected by hydration status.
Limited statistical power to evaluate outcomes in obese patients who met the H-sarcopenia criteria.
Exclusion of patients with severe functional impairment, advanced disease severity, or inability to maintain a standing position.
Limited generalizability to ambulatory or community-based heart failure populations.

Abstract

Background: The 2025 Asian Working Group for Sarcopenia (AWGS) updated diagnostic criteria redefine sarcopenia based on low muscle strength and low skeletal muscle mass, incorporating body mass index (BMI)-adjusted appendicular skeletal muscle mass (ASM) alongside height-adjusted ASM. The clinical relevance of these definitions in heart failure (HF) patients remains unclear.

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