This study aimed to investigate the association between SARC-F scores and mortality risk in elderly patients with cardiovascular disease. The results of this study revealed that a SARC-F score of ≥4 was significantly associated with a higher risk of all-cause death and re-hospitalization events in this population.
This study observed that the number of patients with CVD having SARC-F ≥ 4 increased with age, was higher in females and in patients with heart failure or diabetes. The aging process encompasses various factors, such as natural declines in muscle mass and strength and increased inflammation, potentially contributing to the onset of sarcopenia [17]. Besides, cardiovascular diseases, especially heart failure, may exacerbate the process of muscle loss (16). Chronic illnesses, especially CVD, can contribute to a state of systemic inflammation and metabolic changes that negatively affect muscle health (16). The combination of aging and the presence of CVD may induce or accelerate progression of sarcopenia. In addition, the most prominent pathway associated with sarcopenia and CVDs is insulin resistance. This phenomenon serves as a significant cardiovascular risk factor, independent of other risk factors, among older adults in community populations and individuals with diabetes (16). In a previous meta-analysis, Liyuan Feng et al. affirmed that sarcopenia was more prevalent in patients with diabetes(17). In accordance with our finding, Kitamura et al. recorded that sarcopenia was more common in women with CVD (18).
Our study revealed a significant correlation between higher SARC-F scores and the presence of comorbidities. Certain comorbidities, such as diabetes, coronary heart disease, and vision problems, were identified as predictors of lower muscle strength in individuals aged 50 and older(19). Additionally, muscle mass and strength have been linked to elevated levels of inflammatory markers in patients with chronic diseases (20). Angulo J. et al. found that multimorbidity at baseline was associated with a higher risk of sarcopenia during a twelve-year follow-up (21). Similarly, a systematic review by Pacifico et al. reported that individuals with dementia, diabetes, and respiratory diseases had a notably higher prevalence of sarcopenia compared to those without these conditions (22). Sarcopenia shares many risk factors with CVD, dementia, diabetes, and respiratory disease, such as sedentary behavior, low physical activity, inflammation, malnutrition, and various other mechanisms. This shared risk profile may explain the higher prevalence of sarcopenia in individuals with these age-related diseases (22). Consequently, there is a critical need to raise awareness and implement preventative strategies targeting both sarcopenia and its associated comorbidities.
Our findings suggest that a SARC-F score of 4 or higher is a predictor of a worse prognosis, including readmission or mortality post-discharge, in patients with CVD compared to those in the non-sarcopenia group (a score below 4). The identification of sarcopenia using the algorithm proposed by the European Working Group on Sarcopenia in Older People (EWGSOP), Yang et al. reported that this situation was associated with mortality during hospital stay and 1-year post-discharge among hospitalized older adults (7). A a previous study by Ueshima J et al., a SARC-F≥4 score was a predictor of death within 30 days of hospitalization (23). Takumi Noda et al. found that sarcopenia assessment using the SARC-F was associated with increased in-hospital mortality in older patients, as well as heightened short-term mortality in individuals with CVD (24). A primary factor that leads to increased mortality in sarcopenia patients is the higher fall risks, which results from the reduction in muscle mass and strength that impairs the balance (25). Along with osteoporosis and malnutrition, which are common in the elderly, there is an elevated risk of fracture from falls, often necessitating hospitalization (26). The reduced activity and extended bed rest associated with hospital stays can further diminish muscle mass and strength (27), exacerbating functional deterioration and increasing the likelihood of post-discharge falls and readmissions (28). Additionally, sarcopenia is linked to more extended hospital stays, and muscle loss during hospitalization can create a vicious cycle of functional decline and repeated hospital admissions, potentially increasing mortality (27). This is particularly vital to improve the overall health and cardiovascular well-being of elderly patients with CVD during their hospital stays. Therefore, early identification and diagnosis of sarcopenia in primary care settings and hospitals are vital for initiating preventive or intervention strategies, thus mitigating the risks associated with sarcopenia and reducing the overall healthcare burden and expenses.
Sarcopenia is not merely a reduction in muscle mass but reveals significant implications for functional abilities. The increased challenges in strength, mobility, and performing daily activities among individuals with sarcopenia emphasize the clinical relevance of assessing these components. Our study revealed an association between higher SARC-F scores and poorer functional outcomes. In the African American Health (AAH) cohort, participants with SARC-F scores ≥ 4 exhibited slower chair stand times and weaker grip strength(5). Similarly, in the NHANES 1999–2006 survey, individuals with SARC-F scores ≥ 4 demonstrated slower walking times and weaker knee extension strength compared to the control group(5). These findings highlight the value of employing comprehensive assessment tools like SARC-F. The robust associations identified in our analysis further underscore the utility of SARC-F in identifying and understanding sarcopenia, especially in elderly populations, particularly those with cardiovascular disease.
It is worth noting that this study has some limitations. Firstly, the study was conducted at a single tertiary hospital, which may limit the generalizability of the findings to other settings. Secondly, the responses to the SARC-F questionnaire by some patients may have been influenced by undetected, subtle, transient cognitive impairments associated with their acute condition. Finally, the study lacked a control group of younger individuals for comparison of SARC-F values between older and younger subjects.
Despite such limitations, the study addresses a gap in the context of dementia and its risk factors among Vietnamese people. This study has major strengths by addressing a gap in the literature regarding the role of the SARC-F questionnaire for predicting risk of adverse outcomes among Vietnamese elderly patients with cardiovascular disease. The study by Shinya Tanaka et al. has indicated that combining physical function measures with the SARC-F questionnaire might enhance predictive accuracy in elderly patients with CVD upon admission. This combined approach did not result in a statistically significant difference when compared to using the SARC-F questionnaire alone (29). These findings suggest that in clinical settings where time constraints limit the feasibility of conducting extensive physical function assessments, the SARC-F questionnaire should be a recommended and practical tool for prognostic evaluation among this patient population.
The study's findings have important clinical implications. The SARC-F questionnaire can be easily administered in a clinical setting, making it a valuable tool for identifying elderly CVD patients at a higher risk of adverse outcomes. Early identification of these high-risk patients can help healthcare providers implement appropriate interventions and strategies to improve patient outcomes and reduce the burden of re-hospitalization.
Future prospective studies employing more age groups, larger sample sizes, and a comprehensive panel of risk factors in a multicenter clinical trial can provide further insights into the predictive utility of SARC-F for adverse outcomes in the elderly.