Consolidating Concepts from Recent International Expert Consensus on Sarcopenia: Implications for Heart Failure Management.

Heart failure is a clinical syndrome associated with a range of pathophysiological disorders including secondary sarcopenia that reduces patients' quality of life, mobility, physical fitness and capacity to undergo rehabilitation and recovery from acute decompensation. Although international expert writing groups have convened and developed consensus documents for sarcopenia, the vast majority of the content has focused on the disorder from the aging perspective.

Heart failure is rarely or not considered in the available consensus statements and recommendations. Moreover, there are differences in the sarcopenia diagnostic criteria pertaining to race/ethnicity (translating into differences in body composition and anthropometry), investigative methodologies, practice pattern, and variation in access to healthcare resources across nations that are not discussed in the current heart failure management guidelines.

Here, we review the key contents from the recent major international consensus documents on sarcopenia published between 2019 and 2024; highlight the gaps in knowledge (e.g. sarcopenic obesity, cardiac atrophy/wasting) and recent developments in heart failure treatment (e.g.

sodium glucose co-transporter 2 inhibitor) and intervention (e.g. rehabilitation, inspiratory muscle training) that may benefit sarcopenia; and reformulate the 4-step pathway of early screening, investigation, diagnosis, and severity determination ("Find-Assess-Confirm-Severity") for sarcopenia as a vital part of heart failure management under a multidisciplinary care team.