Muscle or Heart? Functional Impact of Sarcopenia and Heart Failure in Geriatric Inpatients

Objectives: To evaluate the individual and combined impact of sarcopenia (SARC) and heart failure (HF) on functional performance, systemic biomarkers, and structural cardiac changes in hospitalized older adults. A total of 598 patients aged ≥65 years admitted to a geriatric unit between January 2023 and December 2024, stratified into four groups based on the presence or absence of sarcopenia and HF. Methods: Muscle strength (handgrip), gait speed, SPPB score, and calf circumference were assessed, along with inflammatory/nutritional markers and echocardiographic parameters. Sarcopenia was diagnosed according to EWGSOP2 criteria and HF was diagnosed according to ESC 2021 guidelines. Results: Functional impairment was the most severe in the SARC+/HF+ group, with significantly lower handgrip strength, gait speed, and SPPB scores (p < 0.001). Sarcopenia alone was associated with greater functional decline than HF alone. Serum hemoglobin and albumin levels were reduced in sarcopenic groups, while NT-proBNP and cardiac remodeling indices (IVS and LVEDD) were highest in patients with both conditions. Conclusions: Sarcopenia exerts a significant impact on physical performance in older adults, surpassing that of HF in isolation. The coexistence of sarcopenia and HF amplifies vulnerability and clinical decline, supporting the need for integrated assessment and early muscle-targeted interventions in geriatric cardiology.