Prognostic utility of the Global Leadership Initiative on Sarcopenia model in older patients with heart failure: post-hoc analysis of the FRAGILE-HF study

Abstract Aims The Global Leadership Initiative on Sarcopenia (GLIS) defines sarcopenia based on muscle mass, muscle strength, and muscle-specific strength, considering physical performance as an outcome rather than a diagnostic criterion. This study aimed to evaluate whether the GLIS model can effectively assess the prognostic value and impaired physical performance in older patients with heart failure. A post-hoc analysis of the FRAGILE-HF study, a multicentre prospective observational cohort study, was conducted. Methods The analysis included 891 patients (median age: 81 [interquartile range: 74–86] years; 41.9% women) hospitalized for heart failure. Sarcopenia and possible sarcopenia were assessed using the GLIS model. The primary outcome was 2-year all-cause mortality, and the secondary outcome was impaired physical performance, including 6-minute walk distance. Results According to the GLIS model, sarcopenia and possible sarcopenia were observed in 186 (20.9%) and 539 (60.5%) patients, respectively. Sarcopenia was associated with significantly increased 2-year mortality (adjusted hazard ratio 3.38, 95% confidence interval [CI] 1.74–6.56, P < 0.001). Sarcopenia and possible sarcopenia were significantly associated with impaired physical performance. The diagnosis of sarcopenia based on the GLIS model provided superior prognostic discrimination compared to the diagnosis based on the conventional Asian Working Group for Sarcopenia 2019 model (net reclassification improvement 0.269, 95% CI 0.141–0.397, P < 0.001). Conclusion The diagnosis of sarcopenia based on the GLIS model was associated with prognosis and impaired physical performance in older patients with heart failure.