Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI‐HF and Val‐HeFT trials

Abstract

Aims Uncertainties remain on the biological and prognostic significance and therapeutic implications of loss in body weight (W‐LOSS) in chronic heart failure (HF) patients. We assessed whether W‐LOSS added additional prognostic value to classical clinical risk factors in two separate and large cohorts of patients with chronic HF. The factors associated with W‐LOSS were studied. Methods and results W‐LOSS and estimated plasma volume changes were measured serially in the GISSI‐HF (n = 6820) and Val‐HeFT trials (n = 4892). In both studies, experiencing at least one episode of ≥5% W‐LOSS during the first year of follow‐up was considered a sign of wasting. In GISSI‐HF, self‐reported unintentional W‐LOSS ≥2 kg between two consecutive clinical visits within 1 year was also considered a sign of wasting. W‐LOSS occurred in 16.4% and 15.7% of the patients enrolled in GISSI‐HF and Val‐HeFT, respectively (unintentional ≥2 kg W‐LOSS occurred in 18.9% in GISSI‐HF). In multivariable analyses adjusting for a number of baseline covariates as well as for plasma volume changes, W‐LOSS was found to be independently associated with mortality and adverse cardiovascular and non‐cardiovascular outcomes, with a significant net reclassification improvement (cfNRI) and an increase in integrated discrimination improvement (IDI). W‐LOSS was independently associated with several features representing the severity of HF, including baseline NT‐proBNP and high sensitivity C‐reactive protein (hsCRP) in Val‐HeFT. Conclusions W‐LOSS was a frequent finding in the GISSI‐HF and Val‐HeFT trials, associated with multiple patient features, and added additional prognostic information beyond clinical variables of HF severity, including estimated plasma volume changes.

Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults

“…Recent changes in their body mass are another measure of both severity of illness and current nutritional status. In longitudinal studies of elderly heart failure patients, unintended weight loss was associated with increased risk of cardiovascular adverse events 11–13 . Patient height and weight in STSCHSSD are limited to measurements at the time of their operation, and thus it was not possible to identify recent changes in BMI.…”

“…In elderly cardiac surgery patients, underweight status is associated with increased risk of mortality and adverse events 4–7 . In longitudinal studies of elderly heart failure patients, unintended weight loss is independently associated with increased risk of adverse events 11–13 . In CHD patients, residual anatomic disease, myocardial dysfunction, and non-cardiac disease all could result in an analogous heart failure syndrome.…”

Muscle wasting and cachexia in heart failure: mechanisms and therapies

“…Among echocardiographic para meters, the combination of right ventricular dysfunction and elevated right atrial pressure provided the best discrimin ation between patients with or without cachexia 6 . A study published in 2015 to examine the Val-HeFT and GISSI-HF trials retrospectively showed that unintentional body weight loss ≥5% occurred in 15.7% and 16.4% of enrolled patients, respectively 7 . The weight-loss criterion in this study (unintentional body weight loss ≥5%) does not fulfil the definition of cachexia, which should include either a higher cut-off point or additional variables.…”

Cardiac Cachexia: Perspectives for Prevention and Treatment

“…Its occurrence predicts reduced survival, independent of relevant variables such as age, heart failure functional class, ejection fraction, and physical capacity. 4 We evaluate studies on heart failure-induced cachexia and discuss different therapies for its prevention and treatment.…”