Abstract
BACKGROUND: Heart failure (HF) is associated with high mortality and poor prognosis in older adults. Reduced skeletal muscle mass and low bone mineral density are prevalent comorbidities in this population; however, their combined impact on clinical outcomes remains underexplored. AMIS: This study aimed to investigate the prognostic impact of reduced skeletal muscle mass and bone mineral density in older adults with HF. METHODS AND RESULTS: In this retrospective, single-center cohort study, 412 older HF patients (aged ≥ 60 years) were classified into four groups based on thoracic CT-derived vertebral bone density (VBD) and skeletal muscle index (SMI): normal VBD and SMI, low SMI alone, low VBD alone, and combined low VBD and SMI. All-cause mortality was assessed over a median follow-up of 729 days (IQR: 686-764). Patients with combined low SMI and VBD had the highest mortality (33.3% vs. 15.3% in the normal group; p = 0.032). Multivariable Cox regression showed that combined low SMI and VBD independently predicted mortality (adjusted HR = 2.18; 95% CI: 1.12-4.24; p = 0.021), whereas isolated deficits were not statistically significant. CONCLUSIONS: The coexistence of reduced skeletal muscle mass and bone density synergistically increases mortality risk in older adults with HF. Early identification of musculoskeletal deficits through CT-based assessments may facilitate targeted interventions to reduce adverse outcomes. Integrated strategies addressing both bone and muscle loss are essential for improving long-term prognosis in this vulnerable population.