Sarcopenia and frailty: risk profiles in patients with chronic heart failure

Abstract

Introduction. Patients with heart failure frequently present with varying degrees of skeletal muscle dysfunction, from early fatigue to sarcopenia and cachexia. Sarcopenia, defined as the loss of muscle mass and/or function, contributes to the physical dimension of frailty. Both conditions are associated with adverse outcomes in heart failure. Although sarcopenia and frailty often coexist, they are distinct syndromes with a bidirectional relationship with heart failure. According to European data, the prevalence of sarcopenia ranges from 20-50% in heart failure with reduced ejection fraction and approximately 18% in heart failure with preserved ejection fraction. This study aimed to evaluate sarcopenia among frail patients with chronic heart failure and to identify associated risk and protective factors. Material and methods. A cross-sectional observational study was conducted on 44 frail patients with chronic heart failure. Data collection included clinical, functional, and anthropometric parameters, using the SARC-Calf questionnaire, gait speed and the Timed Up and Go test. Patients were stratified into three study groups according to frailty severity assessed by the Edmonton Frail Scale: Study Group 1 – mild frailty, Study Group 2 – moderate frailty, and Study Group 3 – severe frailty. Statistical analysis included Chi-square and Fisher’s exact tests. Odds Ratios with 95% Confidence Intervals were calculated. A p < 0.05 was considered statistically significant. Results. Of the 44 patients included, 32 (72.7%) were women and 12 (27.3%) men, with a mean age of 67.3 ± 8.9 years. Sarcopenia risk (SARC-Calf ≥4) was identified in 56.8%, and severe sarcopenia in 15.9%, exclusively among women. Functional impairment was present in 88.9% of Study Group 1, 91.7% of Group 2, and 100% of Group 3. Arterial hypertension (71.4%), diabetes mellitus (57.1%), and obesity (42.8%) were more prevalent among sarcopenic patients. C-reactive protein levels >6 mg/L and elevated NT-proBNP were associated with sarcopenia risk (p = 0.039). Metformin use was linked to absence of sarcopenia (p = 0.008), while low physical activity, statin use, and inflammation were more frequent in sarcopenic patients. Conclusions. Sarcopenia was highly prevalent in frail heart failure patients, particularly among women. Cardiac dysfunction, inflammation, and metabolic comorbidities are key contributors, highlighting the need for early screening and tailored interventions.