Korean Circ J.  2024 Jul;54(7):363-381. 10.4070/kcj.2024.0089.

Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure

• Maeda D
• Fujimoto Y
• Nakade T
• Abe T
• Ishihara S
• Jujo K
• Matsue Y

• KMID: 2557976
• DOI: http://doi.org/10.4070/kcj.2024.0089

Abstract

With global aging, the number of patients with heart failure has increased markedly. Heart failure is a complex condition intricately associated with aging, organ damage, frailty, and cognitive decline, resulting in a poor prognosis. The relationship among frailty, sarcopenia, cachexia, malnutrition, and heart failure has recently received considerable attention. Although these conditions are distinct, they often exhibit a remarkably close relationship. Overlapping diagnostic criteria have been observed in the recently proposed guidelines and position statements, suggesting that several of these conditions may coexist in patients with heart failure. Therefore, a comprehensive understanding of these conditions is essential, and interventions must not only target these conditions individually, but also provide comprehensive management strategies. This review article provides an overview of the epidemiology, diagnostic methods, overlap, and prognosis of frailty, sarcopenia, cachexia, and malnutrition in patients with heart failure, incorporating insights from the FRAGILEHF study data. Additionally, based on existing literature, this article discusses the impact of these conditions on the effectiveness of guideline-directed medical therapy for patients with heart failure. While recognizing these conditions early and promptly implementing interventions may be advantageous, further data, particularly from well-powered, large-scale, randomized controlled trials, are necessary to refine personalized treatment strategies for patients with heart failure.

Keyword

Heart failure; Frailty; Sarcopenia; Cachexia; Malnutrition

Figure

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  Figure 1 Overlap among frailty, sarcopenia, cachexia, and malnutrition in the FRAGILE-HF study.This Venn diagram shows the number of overlaps among frailty, sarcopenia, cachexia, and malnutrition using data from the FRAGILE-HF study. A total of 851 patients hospitalized with heart failure were analyzed.

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  Figure 2 Kaplan–Meier curves for all-cause mortality based on the number of the presence of frailty, sarcopenia, cachexia, or malnutrition.This figure is illustrated using data from the FRAGILE-HF study. The patients were divided into five groups according to the presence of frailty, sarcopenia, cachexia, and malnutrition.

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