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Anorexia aggravates disease progression in heart failure

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Researchers of the German Centre for Cardiovascular Research (DZHK) have discovered that patients with heart failure who have anorexia are also more affected in their physical functional capacity and have worse prognosis. Factors that encourage anorexia are the intake of diuretic medication, inflammation, and involuntary weight-loss.

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More than 80 percent of patients with heart failure are elderly people who, for the most part, also suffer from co-morbidities. These additional health problems affect the fitness, quality of life and survival of patients with heart failure. For instance, typical co-morbidities are muscle wasting and involuntary weight-loss due to muscular degeneration. Anorexia is also frequently observed in patients with advanced heart failure. Yet until now, little was known about how loss in appetite affects disease progression in these patients. PD Dr. Dr. Stephan von Haehling of the University Medical Center Göttingen and his colleagues have thus investigated whether anorexia affects the physical functional capacity and the survival rate of patients with heart failure in the SICA-HF study (Studies Investigating Co-morbidities Aggravating Heart Failure) funded by the European Commission. Moreover, they searched for factors that may contribute to anorexia.

An adverse combination

A total of 166 clinically stable outpatients with heart failure were asked whether they had lost their appetite and a third stated that they were indeed suffering from anorexia. The physical functional capacity of study participants was ascertained using balance exercises, a 6-minute walking test and endurance and strength tests, among other things. This demonstrated that the functional capacity was worse if the study participant’s appetite was diminished. The fitness level was even more affected if in addition to a loss in appetite (anorexia), involuntary, severe weight-loss (cachexia) was present.

More fatalities with a diminished appetite

The DZHK researchers in Göttingen also discovered that the mortality risk is increased over two years if patients with heart failure have anorexia. Cachexia also had an additional negative effect here. “The combination of cachexia and anorexia is complex and also a problem in other chronic diseases”, says von Haehling. “This is why the “anorexia-cachexia syndrome” is known for instance in cancer patients as a negative consequence of the disease and its treatment poses a big challenge”.

Possible triggers

In the search of factors which encourage anorexia in heart failure, the researchers found three independent predictors: the activation of inflammatory hormones, the intake of loop diuretics and cachexia. “Increased inflammatory markers are already present in patients with heart failure. If these markers are exceeded, it becomes more likely that their appetite diminishes”, explains von Haehling. The loop diuretics are prescribed to patients with heart failure to reduce water retention in the tissue. Presumably, due to the loss of trace elements like zinc, they can cause the sense of taste and thus also appetite to lessen.

The researchers believe that treating physicians need to keep an eye on the eating habits and the nutritional condition of their patients when treating heart failure. “These factors should be a fundamental part of the overall medical assessment of patients with heart failure”, recommends von Haehling.

Original study: Anorexia, Functional Capacity, and Clinical Outcome in Patients with Chronic Heart Failure: Results from the Studies Investigating Co-Morbidities Aggravating Heart Failure (SICA-HF). Saitoh, M., Dos Santos, M. R., Emami, A., Ishida, J., Ebner, N., Valentova, M., Bekfani, T., Sandek, A., Lainscak, M., Doehner, W., Anker, S. D. & von Haehling, S. ESC heart failure, (2017)
DOI: 10.1002/ehf2.12209

Contact: Christine Vollgraf, Public Relations Officer, German Centre for Cardiovascular Research (DZHK), phone: +49 30 3465 529 02, presse(at)dzhk.de

PD Dr. Dr. Stephan von Haehling, Cardiology and Pneumology, Heart Center Göttingen, University Medical Center Göttingen, stephan.von.haehling(at)web.de