A review of cardiac cachexia: Characteristics, pathophysiology, and therapeutic management

The aim of this review was to introduce cardiac cachexia for health care team, especially nurses. Acquaintance of health care providers with cardiac cachexia may lead them to pay more attention to this phenomenon when taking care of heart failure patients with cardiac cachexia. Heart failure is a systemic condition starting with heart dysfunction followed by dysfunction of most body organs including cardiovascular, musculoskeletal, renal, neuroendocrine, immune, haemostatic, and inflammatory systems. Heart failure is already considered as a multisystem disease which can lead to such morbidities as anemia, insulin resistance, autonomic nervous system imbalance, and cardiac cachexia. Despite the importance of cachexia phenomenon in people with heart failure, it seems that it is not sufficiently considered by health care providers in the treatment and care program. In this paper, a review was conducted on the studies published between 1999-2016 about cardiac cachexia. The studies were searched out through scientific databases, including PubMed and Science Direct by the keywords heart failure and cachexia. The search resulted in 493 papers out of which 41 paper were considered in this review. In the last two decades, many attempts have been made to determine a unified definition of the cachexia. An anabolic/ catabolic imbalance with the dominance of catabolism which is the result of a combination of immunologic, metabolic, and neuroendocrine processes has been considered as pathophysiology of cardiac cachexia. In the early period after development of chronic heart failure, most of these processes are activated to protect heart and circulatory system from damage and also, to compensate for decreased cardiac muscle performance. Mechanisms of cachexia development are multiple, and it is necessary for treatment to consider several mechanisms simultaneously. Therapeutic management is based on prevention, exercise, nutrition, and drugs. Cardiac cachexia as a complication of chronic heart failure has adverse effects on patients’ quality of life and outcomes. The success of strategies for prevention or treatment of cardiac cachexia greatly depends on patients adherence to therapeutic regimen; multidimensional nature of strategies makes it necessary to be implemented in a comprehensive and right way.