Association between cachexia and falls or prognosis in older patients with heart failure receiving home-visit rehabilitation in Japan: a one-year follow-up study
M Saitoh, K Oura, K Furuta, K Tobita, Y Onimura, A Yamada, H Tanaka, T Dohi, D YuminoAbstract
Background
Cachexia is a common and clinically significant complication in older patients with heart failure (HF) who require home-visit rehabilitation (HVR) under the Japanese medical or long-term care system because of impaired physical function1,2); however, its prevalence and prognostic implications in this population remain unclear.
Purpose
This study aimed to investigate the prevalence of cachexia among older patients with HF receiving HVR and to examine its association with adverse events, including falls and all-cause mortality, during the one-year period following HVR initiation.
Methods
The study population comprised older patients with HF who were receiving HVR. A total of 106 participants (median age, 87 years［interquartile range, 60-91］; 57% female) were included, and data from baseline through the 12-month follow-up were analyzed. Cachexia was diagnosed according to the criteria established by the Asian Working Group for cachexia (AWGC). The primary outcome was all-cause mortality; the incidence of falls during follow-up was also assessed. Survival analysis was performed using multivariable Cox proportional hazards models, and logistic regression analysis was conducted to evaluate the association between cachexia and falls.
Results
Of the 106 participants, 73 patients (68.9%) met the AWGC-defined criteria for cachexia. Patients with cachexia were more likely to be female and had lower body mass index, hemoglobin level, and Mini-nutritional assessment-Short form score than those without cachexia (all P < 0.05). Compared with the non-cachexia group, patients with cachexia had significantly lower Barthel index score (70［60-85］vs. 85［73-90］points, p<0.01), lower homebound life-space mobility scores (42［36-62］ vs. 68［47-74］points, p<0.01), and a higher prevalence of physical frailty based on Japanese version of the Cardiovascular Health Study criteria (84.9% vs. 48.5%, P<0.01). Prognostic data were available for 94 patients; 31 deaths (33.0%) and 53 falls (56.4%) were observed. In a multivariable Cox proportional hazards analysis, AWGC-defined cachexia was independently associated with all-cause mortality (hazard ratio, 3.002; 95% confidence interval［CI］, 1.124–8.022; P = 0.028) after adjustment for age, sex, ventricular ejection fraction, NYHA functional class. Similarly, logistic regression analysis demonstrated that cachexia remained an independent risk factor for falls after adjustment for age, sex, physical frailty, homebound life-space mobility, and Mini-Mental State Examination score (odds ratio, 3.719; 95% CI, 1.188–11.643; P = 0.024).
Conclusion
Cachexia was highly prevalent among older patients with HF receiving HVR and was independently associated with increased risks of all-cause mortality and falls over one year, underscoring its substantial clinical and prognostic significance in this vulnerable population.Figure_Kaplan-Meier curve