Prognostic impact of cachexia by multi‐assessment in older adults with heart failure: FRAGILE‐HF cohort study

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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; <jats:italic>P</jats:italic> = 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; <jats:italic>P</jats:italic> = 0.025) and 1.561 (95% CI, 1.086–2.243; <jats:italic>P</jats:italic> = 0.017), respectively. Among the cachexia diagnostic criteria, decreased muscle strength (HR, 1.514; 95% CI, 1.095–2.093; <jats:italic>P</jats:italic> = 0.012) and low fat‐free mass index (HR, 1.424; 95% CI, 1.052–1.926; <jats:italic>P</jats:italic> = 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; <jats:italic>P</jats:italic> = 0.277) and all‐cause mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>