Prognostic implication of sarcopenia diagnosed by updated Asian Working Group for Sarcopenia criteria in older patients with heart failure: Utility and limitation

Objectives: The utility of the updated Asian Working Group for Sarcopenia (AWGS) criteria in diagnosing sarcopenia in older patients with heart failure (HF) remains unclear. Objective: To analyze the prevalence and prognostic impact of sarcopenia diagnosed by the updated AWGS criteria in older patients with HF. Design: Ambispective cohort study. Setting & subjects: 534 older patients with HF from a university hospital in Japan. Measurements: Sarcopenia was assessed using different versions of the AWGS criteria: AWGS 2014, AWGS 2019H (muscle mass relative to height squared), and AWGS 2019B (muscle mass relative to BMI). The primary endpoint was all-cause mortality at three years post-discharge. Results: Of 534 patients, 42%, 57%, and 44% were diagnosed with sarcopenia according to AWGS 2014, AWGS 2019H, AWGS 2019B, respectively. Among patients without AWGS 2014-defined sarcopenia, 23% were reclassified as having sarcopenia by AWGS 2019H criteria. Forty-four percent of sarcopenic patients diagnosed by AWGS 2019H were re-classified as non-sarcopenic by AWGS 2019B, with lower fat mass and poorer nutritional status. After the multivariate Cox proportional hazard analyses, an association between all-cause death and sarcopenia remained significant for AWGS 2014 (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.01-2.37) and AWGS 2019H (HR, 1.65; 95% CI, 1.05-2.59), but not for AWGS 2019B (HR, 0.99; 95% CI, 0.64-1.51). Conclusion: The updated AWGS 2019H criteria detected more sarcopenic patients with HF while maintaining favorable predictive ability. The use of BMI-adjusted muscle mass reclassified underweight and malnourished patients as non-sarcopenic, limiting its impact on the mortality prediction in older patients with HF. (c) 2024 The Authors. Published by Elsevier Masson SAS on behalf of SERDI Publisher. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).