The sarcopenia and frailty conundrum in heart failure: a clinical perspective from the FREE registry

The interplay between sarcopenia and frailty is difficult to delimit and has been little analysed in patients with acute heart failure (HF). This work aims to describe the relationship between sarcopenia and frailty and analyse its impact on congestion and early outcomes.

This is a single-centre observational study. Patients with decompensated HF were classified based on presence of sarcopenia and on presence of frailty. Patients with sarcopenia were analysed in terms of plasma volume variations or natriuretic peptides. A correlation analysis between patients with sarcopenia and functional, cognitive, depression, nutritional and frailty status was performed. The influence of both sarcopenia and frailty on early readmissions was also analysed.

A total of 224 patients (mean age 81.2 years (2.9), 48.7% males) were analysed. Of them, 11.2% had sarcopenia and 74.5% had frailty. Natriuretic peptide levels were higher in those with sarcopenia but haematocrit values were lower. Patients with sarcopenia tended to have haemodilution, though this finding was not significant (46.8% vs 37.2%, p = 0.47). The correlation analysis showed a significant relationship between sarcopenia, and time up and go test. Frailty was related to malnourishment, cognitive and depressive disorders, and the Lawton-Brodie index. Only sarcopenia was independently related to early readmissions (OR 3.2, 95%CI 1.2-8.0, p = 0.01).

The prevalence of sarcopenia and frailty can vary within a population of patients with HF. Sarcopenia associated with muscle dysfunction but not with other domains of frailty determined a poorer congestive status and a higher early readmission rate.