Prevalence and Prognostic Impact of Physical Dysfunction, Cachexia, and Dysphagia in Older Patients With Heart...

Older patients with heart failure (HF) often present with multiple age-related conditions, but these are commonly evaluated in isolation. We aimed to describe the prevalence, overlap, and prognostic implications of physical dysfunction, cachexia, and dysphagia in older patients with HF.

We conducted a single-center retrospective study enrolling hospitalized patients with HF aged ≥65 years who were ambulatory at discharge. Complications at discharge were defined as follows: physical dysfunction was defined as a Short Physical Performance Battery score ≤9, cachexia according to the Asian Cachexia Working Group, and dysphagia as a Food Intake Level Scale score ≤8. Patients were categorized by the number of complications (0-3). The outcome was 1-year all-cause mortality. Among 468 patients (median age 81 years; 43.2% female), physical dysfunction, cachexia, and dysphagia were identified in 50.2%, 43.2%, and 19.4% of patients, respectively. The proportion of patients with 0, 1, 2, and 3 complications was 33.4%, 30.1%, 26.9%, and 9.6%, respectively. In Cox regression analysis, a higher number of complications was associated with higher mortality (hazard ratio 1.97; 95% confidence interval 1.35-2.87; P<0.001). Adding the number of complications to a pre-existing risk model increased the area under the curve from 0.684 to 0.779 (P<0.001).

Concurrent assessment of physical function, cachexia, and dysphagia provides incremental prognostic information beyond established risk predictors in older patients with HF.