The association between sarcopenia and post-discharge outcomes in patients with heart failure: data from the SMILE HF registry

Abstract Introduction Heart failure is associated with wasting syndromes such as sarcopenia. Sarcopenia is known to have a poor prognosis due to worsening physical frailty. There is one study showed that low skeletal muscle mass is a powerful predictor of adverse outcomes in patients with coronary artery disease. Purpose We performed this study to analyze the impact of sarcopenia on post-discharge outcomes in heart failure(HF) patients. Method SMILE HF registry is a multi-center prospective cohort registry conducted at 9 institutions in South Korea from 2019 to 2024. It targeted patients hospitalized for HF and total 1976 patients were enrolled. 761 patients underwent bioelectrical impedance analysis(BIA) prior to discharge. Among them, 5 patients with skeletal muscle index(SMI) values extremely outside the normal range were excluded. As a result, a total of 756 patients were included in the final analysis. According to the AWGS(Asian working group for Sarcopenia) 2019 guidelines, participants were classified into the sarcopenia and normal based on the SMI. The threshold is under 7.0 for males and 5.7 for females. Accordingly, 280 patients were classified as sarcopenia. Analysis about clinical outcomes were done between two groups. Results Patients with sarcopenia were older and had a higher proportion of females compared to the normal group. The sarcopenia group also showed higher proportions of patients with a history of hypertension (HTN) and cerebrovascular disease. They exhibited lower levels of hemoglobin(Hb), HbA1c, and low density lipoprotein(LDL), while NT-pro BNP showed no significant difference between the two groups. On echocardiography, Left atrial volume index were higher in the sarcopenia group(Table1). At 6 months after discharge, the all-cause death incidence rate was 1.9% in the normal group and 5.1% in the sarcopenia group, demonstrating a significantly higher incidence in the sarcopenia group(p=0.016). The incidence rates of rehospitalization due to HF and composite outcome of all-cause death and rehospitalization due to HF show no significant difference between the two groups(3.8% vs 3.6%, p=0.892; 5.8% vs 8.0%, p=0.232). As shown in the Kaplan-Meier curve, rehospitalization due to HF and the composite outcome did not show significant differences between the two groups. However, all-cause death showed a significant difference(p=0.013, adjusted HR=2.62). Simple logistic regression analysis identified age, female sex, Body mass index(BMI), HTN, cardiovascular disease(CVD), Hb, and LDL as factors influencing sarcopenia. After adjusting for covariates, age and BMI were identified as independent risk factors of sarcopenia. The risk of sarcopenia increases with age, and a lower BMI is associated with a higher risk of sarcopenia(Table2). Conclusion In patients with acute HF, sarcopenia was associated with a higher incidence of all cause mortality at 6 months after discharge. Table1 KM curve and Table2