The impacts of sarcopenia and its components on heart failure patients: A systematic review and network meta-analysis.

BACKGROUND

Heart failure (HF) and sarcopenia are prevalent, interrelated conditions that significantly impact older adults. Sarcopenia, characterized by progressive decline in muscle mass, strength, and function, is common in HF and linked to higher mortality, hospitalization, and functional decline. Early recognition is hindered by overlap with frailty, variability in assessment methods, and diagnostic challenges in fluid-overloaded patients. These challenges underscore the importance of clarifying the prognostic role of specific sarcopenia-related components in HF. This study aimed to assess which components related to sarcopenia are the strongest predictors of adverse outcomes in HF patients.

METHODS

We systematically searched PubMed, Web of Science, Embase, and Scopus databases for observational longitudinal cohort studies published until March 2024. The certainty of evidence was evaluated using Confidence in Network Meta-Analysis. A frequentist network meta-analysis was conducted to synthesize hazard ratios (HRs) across sarcopenia-related components. Meta-regression examined potential effect modifiers. Sensitivity analyses were conducted for predictors with potentially influential estimates.

RESULTS

Forty-three studies including 38,768 HF patients were analyzed. The Short Physical Performance Battery (SPPB) was associated with the poorest prognoses (P < .001; HR: 30.22, 95% confidence intervals [CIs]: 20.87-43.75), followed by sarcopenia (P = .20; HR: 9.33, 95% CI: 7.99-10.89), low muscle strength (P = .41; HR: 5.45, 95% CI: 4.58-6.48), low gait speed (P = .63; HR: 4.01, 95% CI: 3.46-4.64), and low muscle mass (P = .77; HR: 3.68, 95% CI: 3.41-3.97). Considerable heterogeneity was observed across studies. Sensitivity analyses showed that the extreme HR for SPPB was influenced by cutoffs of 0 or 10. The certainty of evidence was low to very low across comparisons.

CONCLUSION

The present analysis suggests that SPPB may be the strongest predictor of adverse prognosis in HF, underscoring the potential critical need for targeted interventions. These findings, while suggestive, require confirmation in high-quality studies with standardized assessments.