Sarcopenia is a prevalent comorbidity among older patients with heart failure. This study aimed to evaluate the differences between sarcopenia diagnosed using the Asian Working Group for Sarcopenia (AWGS) 2014 and 2019 criteria in older patients with heart failure.

This study is a post hoc sub-analysis of data from the FRAGILE-HF study, a prospective, multicenter, observational study. The study included 879 patients aged >65 years who were hospitalized for heart failure decompensation and could walk at discharge.

Sarcopenia was diagnosed using criteria from the AWGS 2014 (2014 model) and 2019 (2019 model). The primary outcome was 2-year mortality.

Sarcopenia was identified in 186 (21.1%) patients using the 2014 model and 211 (24.0%) patients using the 2019 model. Over the 2-year follow-up period, 158 (18.0%) deaths occurred.

Adjusted Cox proportional hazard analysis showed that sarcopenia was significantly associated with 2-year mortality in the 2014 model, whereas only severe sarcopenia was associated with mortality in the 2019 model. Both models showed significant net reclassification improvement when sarcopenia was added to the baseline model (2014 model: 0.358, 2019 model: 0.357).

However, no significant difference in net reclassification improvement was observed upon direct comparison between the two models (-0.082, P = 0.376), suggesting comparable performance. The 2014 model shows strong prognostic value for predicting 2-year mortality in patients with heart failure.

Although the 2019 model shows similar prognostic value, particularly for severe sarcopenia, it does not significantly outperform the 2014 model. Geriatr Gerontol Int 2025; ••: ••-••.