Application and evidence gaps of sarcopenia diagnostic criteria in patients with heart failure: a scoping review

Abstract

Background Diagnostic criteria for sarcopenia show heterogeneity in patients with heart failure (HF). This study reviews existing evidence through a scoping review. Methods We searched six databases (PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure [CNKI], and Wanfang) from inception to May 2026. Two reviewers screened literature and extracted data independently. We used narrative synthesis. Results We included 23 studies covering 8 diagnostic criteria. The Asian Working Group for Sarcopenia (AWGS) 2019 (9 studies) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) (7 studies) were most common. The overall prevalence ranged from 8.9% to 65.8%, with wide variation within the same criterion. Only 3 studies performed head-to-head comparisons. Heart failure-specific factors (edema interference, New York Heart Association [NYHA] class limitation, timing of assessment in acute phase) received limited attention. No study assessed sarcopenia at acute decompensation before diuresis. One study evaluated patients with stage B HF, generally considered pre-HF, and was interpreted separately. Eleven studies reported prognostic associations, yet only 1 reported discrimination and reclassification metrics such as concordance index (C-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). External validation of diagnostic and prognostic performance was insufficient. Conclusion Current evidence does not support a unified heart failure-specific diagnostic framework for sarcopenia. Future work should include multicenter prospective cohort studies to establish HF-specific cut-off values, develop assessment protocols for acute decompensated HF and NYHA class IV patients, and conduct large-sample external validation of diagnostic and prognostic performance.