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World J Cardiol. Jan 26, 2021; 13(1): 1-10
Published online Jan 26, 2021. doi: 10.4330/wjc.v13.i1.1
Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting
Matteo Beltrami, Carlo Fumagalli, Massimo Milli
Matteo Beltrami, Massimo Milli, Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
Carlo Fumagalli, Cardiomyopathy Unit, Careggi University Hospital, Florence 50139, Italy
Author contributions: Beltrami M provided the input in writing the paper and performed the majority of the writing; Fumagalli C prepared the figures and tables; Milli M coordinated the writing of the paper.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Matteo Beltrami, MD, Doctor, Postdoc, Cardiology Unit, San Giovanni di Dio Hospital, 3 Via Torregalli, Florence 50142, Italy. beltrami.matteo1@gmail.com
Received: October 20, 2020
Peer-review started: October 20, 2020
First decision: November 16, 2020
Revised: November 25, 2020
Accepted: December 27, 2020
Article in press: December 27, 2020
Published online: January 26, 2021
Abstract

Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients. However, these co-factors often remain unaddressed, resulting in poor quality-of-life, prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality. Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard. Common HF drugs therapy (b-blockers, angiotensin-converting enzyme inhibitors) and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation. However, the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting. For all these reasons we briefly review current knowledge on frailty, sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction, specific "red alert" thresholds in clinical practice and therapeutic approach.

Keywords: Heart failure, Sarcopenia, Cachexia, Frailty, Terapheutic implication, Comorbidities

Core Tip: The last heart failure (HF) guidelines of the European Society of Cardiology dedicate a chapter each for cachexia, sarcopenia and frailty and several studies regarding these topics are coming up. This wealth of information highlights the importance of these co-factors in HF management and are each uniquely relevant to evaluate older patients with HF. It is time to routinely assess cachexia, sarcopenia and frailty that could help in personalized care plan, improve outcomes and reduce hospitalization and institutionalization. However, definitions, pathophysiology and treatment of all these conditions still remain unclear and we briefly summarize the most recent knowledge available in literature.