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• W2073238972 abstract "To the Editor: Cardiac cachexia is a devastating end-of-life condition that consumes its victims, especially elderly adults. The pulmonary edema (water) of congestive heart failure (CHF) leads to shortness of breath (wind) and functional limitation, which is followed by an inability to acquire adequate sustenance through a lack of gastronomic drive (earth) while an unchecked catabolism burns scarce caloric resources (fire). This malady involves body tissue wasting, weight loss, anorexia, and weakness in combination. Individuals with other conditions may also experience cachexia,1 but our work in the cardiovascular critical care service produces a keen sense of urgency when we are asked to intervene. Approximately 15% of individuals with CHF develop cachexia—a significant number, considering its prevalence in the United States is 2%.1-3 Associated mortality may reach 50% within 18 months of initial weight loss.2, 3 The malignant nature of this disease warrants paramount attention to the investigation of cardiac cachexia pathways, diagnosis, and management. A crucial drawback to effective intervention is the lack of a unanimously accepted definition. Many definitions of cardiac cachexia use weight loss as the primary criteria: more than 6% loss within 6 months,3 but weight loss alone cannot account for the complexity of cardiac cachexia. An ideal definition should include clinical factors such as reduced muscle strength, fatigue, anorexia, and abnormal biochemistry in addition to weight loss and body composition change.4 Advances in the comprehension of its pathophysiology would provide help in composing a better definition. The pathophysiology of cachexia specific to CHF is not fully understood. Individuals with CHF have evidence of activation of the neuroendocrine and inflammatory systems, lipolysis, muscle wasting, lack of appetite, and malabsorption.5 Activation of the proinflammatory mediator tumor necrosis factor alpha (TNFα) is associated with this condition and could be the key to understanding the underlying process.5, 6 Organ edema resulting from CHF may cause nausea and poor nutritional intake, further compounding the problem. Little data exist regarding the investigation of the potentially intricate pathways; much of the literature focuses on the generalized process of cachexia. Early detection is difficult, and treatment is complicated. One recent study reported that prealbumin was a good biochemical marker for cardiac cachexia that may allow early detection.7 It has been suggested that corticosteroid use prevents the breakdown of muscle tissue.8 Nutritional regimens and appetite stimulants may improve appetite, although the problem of malabsorption in cachexia exists. Additionally, angiotensin-converting enzyme inhibitors have been shown to reduce weight loss in individuals with CHF.3 Targeted therapies of individual cytokines have failed.5 The ongoing Studies Investigating Co-morbidities Aggravating Heart Failure is the first large clinical trial aimed at collecting comprehensive data on the prevalence and pathways of cardiac cachexia.9 Broader treatment approaches, possibly combining medicinal, nutritional, and physical therapies, should be explored. Cardiac cachexia involves complex mechanisms, diagnostic challenges, and ineffective treatments. Prognosis and quality of life are poor. A concerted effort in the investigation of cardiac cachexia that attempts to address the following concerns is urged: epidemiology, including analysis of subpopulations, especially elderly adults, and comorbidities; definition and diagnosis; pathophysiology and disease mechanisms; and medicinal, nutritional, and physical treatments. The scarce data that exist on cardiac cachexia focuses on stable individuals at home. Studies conducted on unstable individuals and those who are hospitalized or in the intensive care unit with cardiac cachexia merit particular attention and investigation. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Tulman: Concept, wrote paper and did literature search. Tripathi: Concept design, editing, and did literature search. Abel: Concept, editing, verified references. Papadimos: Concept design, wrote paper, edited paper, literature search. Sponsor's Role: None." @default.
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• W2073238972 date "2012-10-01" @default.
• W2073238972 modified "2023-10-16" @default.
• W2073238972 title "Cardiac Cachexia and the Aged: Death by Water, Wind, Earth, and Fire" @default.
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• W2073238972 doi "https://doi.org/10.1111/j.1532-5415.2012.04162.x" @default.
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