Low skeletal muscle index combined with reduced bone density increases mortality rate in older adults with heart failure.

BACKGROUND

Heart failure (HF) is associated with high mortality and poor prognosis in older adults. Reduced skeletal muscle mass and low bone mineral density are prevalent comorbidities in this population; however, their combined impact on clinical outcomes remains underexplored. AMIS: This study aimed to investigate the prognostic impact of reduced skeletal muscle mass and bone mineral density in older adults with HF.

METHODS AND

RESULTS

In this retrospective, single-center cohort study, 412 older HF patients (aged ≥ 60 years) were classified into four groups based on thoracic CT-derived vertebral bone density (VBD) and skeletal muscle index (SMI): normal VBD and SMI, low SMI alone, low VBD alone, and combined low VBD and SMI. All-cause mortality was assessed over a median follow-up of 729 days (IQR: 686-764). Patients with combined low SMI and VBD had the highest mortality (33.3% vs. 15.3% in the normal group; p = 0.032). Multivariable Cox regression showed that combined low SMI and VBD independently predicted mortality (adjusted HR = 2.18; 95% CI: 1.12-4.24; p = 0.021), whereas isolated deficits were not statistically significant.

CONCLUSIONS

The coexistence of reduced skeletal muscle mass and bone density synergistically increases mortality risk in older adults with HF. Early identification of musculoskeletal deficits through CT-based assessments may facilitate targeted interventions to reduce adverse outcomes. Integrated strategies addressing both bone and muscle loss are essential for improving long-term prognosis in this vulnerable population.