Clinical Report: Sarcopenia Assessment in Heart Failure Using the GLIS Framework

Overview

The Global Leadership Initiative on Sarcopenia (GLIS) framework effectively identifies sarcopenia and prognostic risk in older heart failure (HF) patients, outperforming traditional criteria. GLIS-defined sarcopenia correlates with higher 2-year mortality and impaired physical performance, highlighting its clinical relevance in HF management.

Background

Heart failure prevalence is rising globally, especially among older adults, where skeletal muscle impairment significantly impacts symptoms and outcomes. Sarcopenia, characterized by reduced muscle mass, strength, and function, is common in HF and exacerbates disease severity. Traditional sarcopenia definitions rely on physical performance measures that may be confounded by HF symptoms. The GLIS framework introduces muscle-specific strength as a diagnostic component and treats physical performance as an outcome, aiming to improve sarcopenia identification in HF patients.

Data Highlights

Key Findings

• GLIS framework identifies a broader spectrum of sarcopenia in HF patients compared to AWGS criteria.
• Sarcopenia and possible sarcopenia per GLIS are linked to impaired physical performance and higher mortality risk.
• GLIS improves prognostic discrimination and risk stratification beyond conventional sarcopenia definitions.
• Performance-based measures alone may underdetect early or muscle quality-driven sarcopenia in HF.
• Handgrip strength, while commonly used, may not fully capture lower limb muscle deficits relevant to HF.
• Muscle mass and strength assessments during hospitalization and physical performance evaluations post-discharge introduce temporal heterogeneity.

Clinical Implications

Incorporating the GLIS framework into HF care can enhance diagnostic clarity and prognostic accuracy for sarcopenia, enabling personalized management strategies. Early identification of possible sarcopenia offers an opportunity for timely interventions such as exercise training, nutritional support, and cardiac rehabilitation to potentially improve outcomes. Clinicians should consider muscle-specific strength assessments alongside traditional measures to better capture muscle impairment in HF patients.

Conclusion

The GLIS framework represents a promising approach to sarcopenia assessment in heart failure, offering improved detection and prognostic value. Further validation and standardization in diverse HF populations are needed to optimize its clinical utility.

References

1. Nakade et al. 2023 -- Prognostic utility of the Global Leadership Initiative on Sarcopenia model in older patients with heart failure: post-hoc analysis of the FRAGILE-HF study