Prevalence and Prognostic Value of Cachexia Diagnosed by New Definition for Asian People in Older Patients With Heart Failure

The Asian Working Group for Cachexia (AWGC) proposed a new definition of cachexia; however, its impact on cachexia prevalence and overlaps with other conditions, such as sarcopenia and malnutrition, are unclear. We investigated these aspects and the prognostic value of cachexia based on the AWGC on mortality in older patients with heart failure (HF). This study was a secondary analysis of a prospective multicentre cohort, namely, the FRAGILE-HF cohort study. Older (≥ 65 years) patients who had been hospitalized due to decompensated HF were enrolled. We assessed the presence/absence of cachexia based on the AWGC and Evans' criteria. Sarcopenia and malnutrition based on the Asian Working Group for Sarcopenia 2014 and the Global Leadership Initiative on Malnutrition criteria were also assessed to compare their prevalence and the overlaps between them. Patients were stratified in relation to the presence/absence of cachexia based on the AWGC criteria, and their mortality rates were compared. Of the 861 enrolled patients (median [interquartile range] age, 80 years [73-85 years]; male, 58.9%), cachexia, as evaluated based on the AWGC and Evans' criteria, sarcopenia and malnutrition, was present in 74.1%, 36.2%, 20.6% and 55.2% of patients, respectively. AWGC-defined cachexia was most common in the four conditions. All-cause death events occurred in 153 (18.1%) patients in 2 years. AWGC-defined cachexia (adjusted hazard ratio [aHRs], 1.442; 95% confidence interval [95% CI], 0.931-2.233; p = 0.101) was not associated with all-cause mortality in older patients with HF after adjusting for other HF prognosis factors, such as the B-type natriuretic peptide and the Meta-Analysis Global Group in Chronic risk score, whereas cachexia evaluated based on Evans's criteria (aHRs, 1.547; 95% CI, 1.118-2.141; p = 0.009), sarcopenia (aHRs, 1.737; 95% CI, 1.214-2.485; p = 0.003), and malnutrition (aHRs, 1.581; 95% CI, 1.094-2.284; p = 0.015) was associated with all-cause mortality. Three-quarters of older patients with HF had cachexia as evaluated by the AWGC criteria, and this was not associated with a worse prognosis. As the new AWGC cachexia criteria will result in a significantly larger proportion of patients being diagnosed with cachexia, the implementation of the criteria in clinical practice requires further consideration. UMIN-CTR unique identifier: UMIN000023929.