Association of Chronic Heart Failure with Frailty, Malnutrition, and Sarcopenia Parameters in Older Patients-A Cross-Sectional Study in a Geriatric Ward

Abstract

The need to assess sarcopenia and frailty in patients with chronic heart failure (HF) has recently been raised. This cross-sectional study of 416 geriatric ward patients (median age (Me)-82 (IQR, 77-86) years, 77.4% female, 96.9% community dwelling) aimed to assess the prevalence of dynapenia, frailty syndrome, functional and nutritional health, and co-morbidity regarding their HF status. We collected data from comprehensive geriatric assessment. We observed HF in 162 (38.9%) patients, with 80 (49.4%) classified as New York Heart Association (NYHA) class III or IV. HF patients were significantly older, more frequently male, obese, hospitalized in the previous year, burdened with multimorbidity and polypharmacy, classified as frail, dependent on daily living activities, and physically non-active. Ischemic heart disease, atrial fibrillation, diabetes, peripheral arterial disease, anemia, chronic kidney disease, history of myocardial infarction, and stroke were found significantly more often in the HF group. A considerably higher percentage of HF patients had dynapenia (54.9% versus 41.9%, p = 0.02), but the difference was significant only in women. We found no significant difference between HF and no-HF groups regarding muscle performance, except for lower median gait speed in the HF group-0.53 m/s (0.35-0.89 m/s) versus 0.68 m/s (0.44-0.99 m/s), p = 0.02). HF patients significantly more often had low grip strength accompanied by slow gait, suggesting probable severe sarcopenia (40.4% vs. 29% in patients without HF, p = 0.046). In the regression analysis, significantly higher odds for HF were observed for lower mid-arm circumference (MAC) and dynapenia when controlling for age, sex, body mass index (BMI), calf circumference (CC), peripheral arterial disease, history of stroke, ischemic heart disease, atrial fibrillation, and diabetes mellitus. Conclusions: HF geriatric patients are often burdened with frailty, obesity, multimorbidity, and polypharmacy. As a result, they are more likely to present low muscle strength (potential sarcopenia), which is frequently accompanied by functional limitations (suggestive of more advanced stages of sarcopenia). This tendency is evident mainly in older women. Nevertheless, sarcopenia can be independently associated with HF in older patients with multimorbidity and disability who are hospitalized in a geriatric department, as a multivariable logistic regression analysis demonstrated.

Keywords: comprehensive geriatric assessment; frailty; heart failure; malnutrition; multimorbidity; older adults; sarcopenia.

Figure 1

Flow chart of patient enrollment.

Figure 2

Prevalence of heart failure (HF) in the study group, where: NYHA, New York Heart Association.

Figure 3

Co-prevalence of sarcopenia (SP) and functional decline (FD) in heart failure (HF“+”) and non-heart failure (HF“−“) study group, where: SP—probable sarcopenia (low hand grip strength according to EWGSOP2); FD—functional decline (gait speed ≤ 0.8 m/s and/or TUG ≥ 20 s).