Association between cardiac cachexia and adverse outcomes in patients with heart failure: a meta-analysis of cohort studies.

Abstract

Cardiac cachexia is a condition characterised by unintentional weight loss and muscle wasting in patients with heart failure. However, there is debate about the prognostic value of cardiac cachexia in these patients. This meta-analysis aimed to evaluate the prognostic value of cardiac cachexia in patients who had heart failure. We conducted a thorough literature search of the PubMed, Web of Science and Embase databases until 7 February 2025 to identify studies that examined the prognostic value of cardiac cachexia in patients with heart failure. The outcomes of interest were all-cause mortality and major adverse cardiovascular events (MACEs). The prognostic value of cachexia was determined by pooling the adjusted HR with a 95% CI. Nine studies, including 3821 patients with heart failure, met the inclusion criteria. Depending on the different definitions, the prevalence of cardiac cachexia varied from 11.2% to 37.8% in the included studies. A meta-analysis using a fixed-effects model showed that cardiac cachexia was associated with an increased risk of all-cause mortality (HR 1.59; 95% CI 1.34 to 1.89) and MACEs (HR 2.41; 95% CI 1.50 to 3.85). Subgroup analysis revealed that cardiac cachexia significantly predicted all-cause mortality, regardless of study design, heart failure subtypes, sample sizes, country, patients' age, definitions of cachexia, length of follow-up, baseline body mass index, left ventricular ejection fraction, and whether adjustment for renal function, smoking status, New York Heart Association class or heart failure medications was made. Cardiac cachexia is associated with a higher risk of all-cause mortality and MACEs in patients with heart failure. Assessing cardiac cachexia may provide valuable prognostic information for these patients.