Heart failure prognosis could be dramatically improved by abandoning one-size-fits-all muscle strength assessments in favor of personalized thresholds that account for a patient's age and sex. This shift toward precision medicine in cardiovascular care challenges the widespread clinical practice of using universal sarcopenia cut-offs that may misclassify risk in vulnerable older adults.
Analysis of 9,693 hospitalized heart failure patients aged 65 and older revealed striking variations in optimal muscle health thresholds across demographic groups. Handgrip strength cut-offs ranged from 24.5 kg in younger men to 11.6 kg in women over 85, while gait speed and physical performance thresholds showed similar age-related declines. These tailored metrics demonstrated robust predictive power, with mortality risk ratios spanning 1.44 to 3.25 across different muscle health measures when age and sex were factored into the assessment.
The personalized approach consistently outperformed standard Asian Working Group sarcopenia criteria across multiple statistical measures, including significant improvements in risk classification accuracy. This suggests that current clinical guidelines may be systematically misidentifying high-risk patients by failing to account for the natural decline in muscle function with aging and biological differences between sexes. For clinicians managing heart failure in aging populations, these findings point toward a more nuanced assessment strategy that could better identify patients requiring intensive intervention. However, the study's focus on Asian populations and hospitalized patients limits immediate generalizability, and validation across diverse ethnic groups and outpatient settings remains necessary before widespread clinical adoption.