Cardiac Cachexia: Diagnostic Complications with Focusing on Weight Loss

Introduction: Cardiac cachexia is a syndrome that may occur in patients with advanced heart failure (HF); however, clinical identification remains challenging. Unexplained weight loss is often the first symptom reported by patients and their caregivers, warranting clinical investigation. This study explored the difficulties applying the cachexia diagnostic criteria of Evans et al. (2008) within a HF population.
Methods: A cross-sectional study was conducted in the Belfast Health and Social Care Trust, recruiting 200 patients with NYHA III-IV HF. Patients were assessed for cachexia based on the following: 5% weight loss in ≤12 months or BMI <20 kg/m2 plus three of: (1) decreased muscle strength, (2) fatigue, (3) anorexia, (4) low fat-free mass index, and (5) abnormal biochemistry (elevated inflammatory markers (CRP and IL-6), anaemia (Hb < 12 g/dL) and serum albumin (<3.2 g/dL)).
Results: Oedema was present in 60.5% of the sample, with 30 patients (15%) identified with cardiac cachexia. The cachectic group had significantly (p < 0.05) lower BMI (21.8 vs. 29.9), but also fat-free mass index, muscle strength, red blood cell count and albumin; and significantly higher C-reactive protein (30.7 vs. 15.3), fatigue and anorexia issues.
Conclusions: Diagnostic criteria identified a 15% prevalence of cachexia within an advanced HF population living in Northern Ireland. Oedema can overshadow diagnosis within clinical practice. The results warrant further research to improve the clinical identification of the syndrome and aid development of a reliable assessment tool. Through early identification, tailored interventions could be implemented to improve patient care and outcomes.