Comparison of sarcopenia prevalence and prognostic features between HFrEF and HFpEF: a systematic review and...

Sarcopenia is closely associated with heart failure (HF); however, no prior meta-analysis has specifically addressed its relation with different ejection fraction phenotypes. This study investigated the prevalence of sarcopenia in patients with HF with reduced ejection fraction (HFrEF) vs. those with preserved ejection fraction (HFpEF), compared their prevalence rates, and explored the prognostic outcomes associated with sarcopenia in these phenotypes.

PubMed, Cochrane, and Embase databases were searched from their inception to February 2025. Studies reporting the prevalence or prognosis of sarcopenia in patients with HF and defined ejection fraction phenotypes were included. Two authors independently assessed study quality using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality. Meta-analyses were conducted using Stata 17, with random-effects models applied to heterogeneous data.

Twenty studies were included: 17 on sarcopenia prevalence in HFrEF, four in HFpEF, four comparing the prevalence between phenotypes, and two comparing prognoses. The pooled prevalence rate of sarcopenia was 35% and 28% in patients with HFrEF and HFpEF, respectively. Subgroup analyses revealed regional variations: Asian populations showed a higher prevalence in HFrEF (48%) that that in HFpEF (16%), whereas European populations exhibited a higher prevalence in HFpEF (44%) than that in HFrEF (27%). In America, the prevalence of sarcopenia in patients with HFrEF was 29%. Age-stratified analyses demonstrated a sarcopenia prevalence of 30% in patients with HFrEF aged ≥65 years vs. 36% in those <65 years. Hospitalized patients with HFrEF had a higher prevalence (45%) than that of the outpatient cohort (23%), whereas hospitalized patients with HFpEF showed a 43% prevalence vs. 16% in outpatients. A meta-analysis of studies directly comparing HFrEF and HFpEF found no significant difference in sarcopenia prevalence (fixed-effect model: RR = 1.12, 95% CI: 1.01-1.23; I ² = 23%, p = 0.273). Prognostic comparisons between patients with sarcopenic HFrEF and HFpEF also showed no significant difference (hazard ratio = 1.57, 95% CI: 0.66-3.77; I ² = 79%, p = 0.029).

In epidemiology, the prevalence of sarcopenia was higher in patients with HFrEF than in those with HFpEF. However, Among studies that include a comparison of the prevalence rates of HFrEF and HFpEF with sarcopenia, meta-analyses have indicated that the ejection fraction phenotype is neither associated with the prevalence of sarcopenia in HF nor with poor outcomes in patients with HF and sarcopenia.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251077599, PROSPERO CRD420251077599.