# Differences in peak oxygen uptake in heart failure patients with and without cachexia: A systematic review and meta‐analysis

## TL;DR

This study finds that heart failure patients with cachexia have significantly lower peak oxygen uptake compared to those without cachexia.

## Contribution

The novel contribution is a systematic review and meta-analysis quantifying the impact of cachexia on peak oxygen uptake in heart failure patients.

## Key findings

- Patients with heart failure and cachexia had a statistically significant reduction in mean VO2peak of -2.21 mL/kg/min compared to those without cachexia.
- Cachexia defined by ≥7.5% weight loss over six months showed a similar significant reduction in VO2peak of -2.47 mL/kg/min.
- Meta-regression found no significant impact of age, sex, BMI, or ejection fraction on the results.

## Abstract

Chronic heart failure (CHF) is characterized by reduced peak oxygen consumption (VO2peak). Cachexia may exacerbate the decline in VO2peak from reductions in muscle mass and strength. We sought to assess differences in VO2peak 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 VO2peak 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 VO2peak compared to their free‐cachexia counterparts.