Heart failure is a growing public health concern. Advanced heart failure is frequently associated with severe muscle wasting, termed cardiac cachexia This process is driven by systemic inflammation and tumor necrosis factor in a manner common to other forms of disease-related wasting seen with cancer or human immunodeficiency virus. A variable degree of malnutrition is often superimposed from poor nutrient intake. Cardiac cachexia significantly decreases quality of life and survival in patients with heart failure. This review outlines the evaluation of nutrition status in heart failure, explores the pathophysiology of cardiac cachexia, and discusses therapeutic interventions targeting wasting in these patients.

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The majority of older patients who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). The prevalence of this syndrome is increasing and prognosis is not improving in comparision to HF with reduced ejection fraction (HFrEF). Patients with HFpEF have severe symptoms of effort intolerance, poor quality-of-life, frequent hospitalizations, and increased mortality. Despite the importance of HFpEF, there are numerous major gaps in our understanding of its pathophysiology and management. Originally viewed as a disorder due solely to abnormalities in left ventricular diastolic function, our understanding has evolved such that HFpEF is now understood as a systemic syndrome, involving multiple organ systems, likely triggered by inflammation and other as yet unidentified circulating factors, and with important contributions of aging and multiple-comorbidities, features generally typical of other geriatric syndromes. Here we present an update on the pathophysiology, diagnosis, management, and future directions in this important disorder among older persons.

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