Cardiac Cachexia Syndrome

Abstract

Heart failure is a chronic, progressive, and incurable disease. Cardiac cachexia is a strong predictor of poor prognosis, regardless of other important variables. This review intends to gather evidence to enable recognition of cardiac cachexia, identification of early stages of muscle waste and sarcopenia, and improve identification of patients with terminal heart failure in need of palliative care, whose symptoms are no longer controlled by usual medical measures. The pathophysiology is complex and multifactorial. There are many treatment options to prevent or revert muscle waste and sarcopenia; although, these strategies are less effective in advanced stages of cardiac cachexia. In these final stages, symptomatic palliation plays an important role, focussing on the patient’s comfort and avoiding the ‘acute model’ treatment of aggressive, disproportionate, and inefficient care. In order to provide adequate care and attempt to prevent this syndrome, thus reducing its impact on healthcare, there should be improved communication between general practitioners, internal medicine physicians, cardiologists, and palliative care specialists since heart failure has an unforeseeable course and is associated with an increasing number of deaths and different levels of suffering.

Mortality among Heart Failure Patients in the Presence of Cachexia

“…According to the European Society of Cardiology (ESC) Guidelines, one of the comorbidities of HF is cachexia, which can be caused by many factors, including catabolic-anabolic imbalances, neurohormonal disorders, pro-inflammatory cytokine activation, anorexia, malabsorption, and anabolic hormone resistance (Sandek et al 2014, Okoshi et al 2014, Valentova et al 2016, Raposo André et al 2017. Although it is unclear if cachexia directly causes death in HF patients, multiple observational studies have shown that cachexia indeed played a role in HF patients' poor prognosis.…”