Chronic heart failure (CHF) is characterized by reduced peak oxygen consumption (VO 2peak). Cachexia may exacerbate the decline in VO 2peak from reductions in muscle mass and strength.

We sought to assess differences in VO 2peak between patients with CHF and cachexia and those without. A systematic literature search of cohort studies via databases (PubMed, Web of Science, Scopus, and Cochrane Library) was conducted from inception until April 2025.

A meta-analysis using a random-effects model was employed. Overall, 10 articles were included in this study.

There was a statistically significant reduction of mean VO 2peak in patients with CHF and cachexia versus those without cachexia (k = 10; MD: -2.21 mL/kg/min, 95%confidence interval [CI]: -2.95 to -1.47, I 2 = 51%, p < 0.01). When cachexia was defined as weight loss of ≥7.5% over the last 6 months, results remained identical (k = 6; MD: -2.47, 95% CI: -2.92 to -2.01, I 2 = 11%, p < 0.01).

Meta-regression analyses regarding age, sex, body mass index, and left ventricular ejection fraction showed no impact as potential moderators, and no publication bias was detected (p > 0.05). CHF patients with cachexia exhibit significantly decreased VO 2peak compared to their free-cachexia counterparts.