Exploring the prevalence, impact and experience of cardiac cachexia in patients with advanced heart failure and their caregivers: A sequential phased study

Matthew A Carson, Joanne Reid, Loreena Hill, Lana Dixon, Patrick Donnelly, Paul F Slater, Alyson J Hill, Susan Piper, theresa McDonagh, Donna Fitzsimons

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Abstract

Background: Cardiac Cachexia is a wasting syndrome that has a significant impact on patient mortality and quality of life world-wide, although it is poorly understood in clinical practice.

Aim: Identify the prevalence of cardiac cachexia in patients with advanced New York Heart Association (NYHA) functional class and explore its impact on patients and caregivers.

Design: An exploratory cross-sectional study. The sequential approach had two phases, with phase 1 including 200 patients with NYHA III-IV heart failure assessed for characteristics of cardiac cachexia. Phase 2
focused on semi-structured interviews with eight cachectic patients and five caregivers to ascertain the impact of the syndrome.

Setting/participants: Two healthcare trusts within the United Kingdom.

Results: Cardiac Cachexia was identified in 30 out of 200 participants, giving a prevalence rate of 15%. People with cachexia had a significantly reduced average weight and anthropometric measures (p < 0.05).
Furthermore, individuals with cachexia experienced significantly more fatigue, had greater issues with diet and appetite, reduced physical wellbeing and overall reduced quality of life. C-reactive protein was significantly increased, whilst albumin and red blood cell count were significantly decreased in the cachectic group (p < 0.05). From qualitative data, four key themes were identified: 1. ‘Changed
relationship with food and eating’, 2. ‘Not me in the mirror’, 3. ‘Lack of understanding regarding cachexia’, and 4. ‘Uncertainty regarding the future’.

Conclusions: Cardiac cachexia has a debilitating effect on patients and caregivers. Future work should focus on establishing a specific definition and clinical pathway to enhance patient and caregiver support.
Original languageEnglish
JournalPalliative Medicine
Early online date21 Jun 2022
DOIs
Publication statusE-pub ahead of print - 21 Jun 2022

Bibliographical note

The author disclosed receipt of the following financial support for the research, authorship, and/or
publication of this article: this work was funded by Northern Ireland Chest Heart and Stroke (grant
reference: NICHS 2018_08

Keywords

  • Cachexia
  • prevalence
  • heart failure
  • quantitative
  • Caregiver

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