RESUMO
Heart failure (HF) can cause metabolic imbalances, leading to anabolic resistance and increased energy expenditure, which often results in weight loss and cachexia. Comprehensive cardiac rehabilitation (CR), including exercise, nutritional support, and risk management, is crucial for enhancing the health and quality of life of patients with HF and is expected to play a central role in the prevention and treatment of HF-associated cachexia. However, the prevalence of cachexia in patients with HF undergoing comprehensive outpatient CR is currently unknown, and the detailed characteristics including of motor function of such patients remain undefined. Therefore, this cross-sectional study aimed to investigate the prevalence and characteristics of cachexia and the relationship between cachexia and lower limb motor function in patients with HF undergoing outpatient CR. This study included 115 consecutive patients with HF (43% male; mean age, 78 ± 8 years) who underwent comprehensive outpatient CR. The cachexia status was assessed according to the definition proposed by the Asian Working Group on Cachexia in 2023. The Short Physical Performance Battery (SPPB) and Mini Nutritional Assessment Short-Form (MNA-SF) were used to evaluate motor function of the lower limbs and nutritional status, respectively. Multivariate logistic regression analyses were used to examine the potential relationship between cachexia and low SPPB scores (≤ 9 points). The prevalence of cachexia was 30% in this study. Compared with those without cachexia, patients with cachexia were significantly older and showed notable reductions in body mass index, MNA-SF scores, handgrip strength, gait speed, and SPPB scores. A multivariate logistic regression analysis, adjusted for confounders, revealed that both age (odds ratio [OR], 1.129; 95% confidence interval [CI], 1.034-1.248; P = 0.016) and presence of cachexia (OR, 3.783; 95% CI, 1.213-11.796; P = 0.022) were independently associated with low SPPB scores. These findings highlight the importance of focusing on cachexia in patients with HF as part of a comprehensive outpatient CR and may be crucial in developing treatments to improve lower limb motor function in patients with HF who develops cachexia.
RESUMO
During the nationwide state of emergency, many hospitals could not provide outpatient cardiac rehabilitation for cardiac disease patients in order to minimize coronavirus disease 2019 (COVID-19) incidence. The purpose of this study was to examine the trajectories of frailty, physical function and physical activity levels due to interruption and resumption of outpatient cardiac rehabilitation by COVID-19 in elderly heart failure patients. Fifteen patients who did not attend outpatient cardiac rehabilitation during the state of emergency but resumed it after the state of emergency were included. Frailty, physical function and physical activity levels were assessed with the Kihon checklist (KCL), various tests including short physical performance battery (SPPB), and life space assessment (LSA), respectively. Objective parameters were measured at three points; before and after the nationwide state of emergency in Japan and 3 months after resuming outpatient cardiac rehabilitation. The post-state of emergency KCL score was significantly higher than the pre-state of emergency score (P = 0.03), whereas there was no significant difference in KCL between post-state of emergency and 3 months after cardiac rehabilitation resumption. SPPB and LSA scores did not change significantly between pre- and post-state of emergency. The changes in LSA from post-state of emergency to 3 months after cardiac rehabilitation resumption tended to correlate with changes in KCL (r = -0.71, P = 0.11). We demonstrated that frailty status deteriorated significantly in elderly heart failure patients whose outpatient cardiac rehabilitation was interrupted due to COVID-19. In addition, the frailty status showed no significant improvement after 3 months of resuming cardiac rehabilitation.
