As the global population continues to age, the healthcare system faces increasing challenges in managing the health and well-being of older individuals (1). Older patients often experience higher mortality rates and require more extensive medical resources during hospitalizations compared to their younger counterparts (2, 3). Therefore, it becomes essential to identify prognostic markers that can effectively forecast outcomes in this vulnerable demographic. Doing so is vital for enhancing patient care quality and optimizing the allocation of healthcare resources.

Sarcopenia, a progressive systemic skeletal muscle disease, is recognized as a key prognostic factor for elderly patients (4). This condition is strongly associated with adverse outcomes in elderly patients, including onset of disability (5), quality of life decline (6), and mortality (7). Besides, cardiovascular disease (CVD), a leading cause of morbidity and mortality in the elderly population, is particularly concerning in relation to sarcopenia (8).

The SARC-F questionnaire, consisting of five questions, offers a simple and cost-effective method for assessing sarcopenia (9). Additionally, the SARC-F has demonstrated a significant correlation between motor function and overall prognosis in individuals with CVD (10). This makes the SARC-F a valuable tool for the early detection of sarcopenia and for evaluating motor function and prognosis in patients with CVD.

While the SARC-F questionnaire has shown promise in identifying sarcopenia (11, 12), studies exploring its association with short-term prognosis remain limited. Understanding the relationship between SARC-F scores and the risk of adverse events can provide valuable insights into the prognostic value of this screening tool. Moreover, such knowledge can aid healthcare professionals in identifying high-risk patients and implementing appropriate interventions to improve outcomes. In Vietnam, the burden of CVD is increasing among older adults due to factors such as sedentary lifestyles, unhealthy diets, and an aging population demographic. Specific challenges faced by elderly patients with CVD in Vietnam include limited access to specialized cardiovascular care and a lack of awareness about cardiovascular risk factors and preventive measures among both patients and healthcare providers. Moreover, such knowledge can aid healthcare professionals in identifying high-risk patients and implementing appropriate interventions to improve outcomes. Therefore, this study aims to investigate the association between SARC-F scores and total combined events, comprising both all-cause death and all-cause re-hospitalization within 6 months’ post-discharge in elderly patients admitted to the Cardiovascular Department of a tertiary hospital in Ho Chi Minh City, Vietnam. By elucidating this association, the study seeks to provide valuable insights into optimizing care for elderly patients with CVD and improving their clinical outcomes in the Vietnamese healthcare context.

This study aimed to investigate the association between SARC-F scores and mortality risk in elderly patients with cardiovascular disease. The results of this study revealed that a SARC-F score of ≥4 was significantly associated with a higher risk of all-cause death and re-hospitalization events in this population.

This study observed that the number of patients with CVD having SARC-F ≥ 4 increased with age, was higher in females and in patients with heart failure or diabetes. The aging process encompasses various factors, such as natural declines in muscle mass and strength and increased inflammation, potentially contributing to the onset of sarcopenia (13). Besides, cardiovascular diseases, especially heart failure, may exacerbate the process of muscle loss (14). Chronic illnesses, especially CVD, can contribute to a state of systemic inflammation and metabolic changes that negatively affect muscle health (14). The combination of aging and the presence of CVD may induce or accelerate progression of sarcopenia. In addition, the most prominent pathway associated with sarcopenia and CVDs is insulin resistance. This phenomenon serves as a significant cardiovascular risk factor, independent of other risk factors, among older adults in community populations and individuals with diabetes (14). In a previous meta-analysis, Feng et al. (15) affirmed that sarcopenia was more prevalent in patients with diabetes. In accordance with our finding, Kitamura et al. (16) recorded that sarcopenia was more common in women with CVD.

Our study revealed a significant correlation between higher SARC-F scores and the presence of comorbidities. Certain comorbidities, such as diabetes, coronary heart disease, and vision problems, were identified as predictors of lower muscle strength in individuals aged 50 and older (17). Additionally, muscle mass and strength have been linked to elevated levels of inflammatory markers in patients with chronic diseases (13). Angulo et al. (18) found that multimorbidity at baseline was associated with a higher risk of sarcopenia during a twelve-year follow-up. Similarly, a systematic review by Pacifico et al. reported that individuals with dementia, diabetes, and respiratory diseases had a notably higher prevalence of sarcopenia compared to those without these conditions (19). Sarcopenia shares many risk factors with CVD, dementia, diabetes, and respiratory disease, such as sedentary behavior, low physical activity, inflammation, malnutrition, and various other mechanisms. This shared risk profile may explain the higher prevalence of sarcopenia in individuals with these age-related diseases (19). Consequently, there is a critical need to raise awareness and implement preventative strategies targeting both sarcopenia and its associated comorbidities.

Our findings suggest that a SARC-F score of 4 or higher is a predictor of a worse prognosis, including readmission or mortality post-discharge, in patients with CVD compared to those in the non-sarcopenia group (a score below 4). The identification of sarcopenia using the algorithm proposed by the European Working Group on Sarcopenia in Older People (EWGSOP), Yang et al. reported that this situation was associated with mortality during hospital stay and 1-year post-discharge among hospitalized older adults (7). A previous study by Ueshima et al. (20), a SARC-F ≥ 4 score was a predictor of death within 30 days of hospitalization. Takumi Noda et al. found that sarcopenia assessment using the SARC-F was associated with increased in-hospital mortality in older patients, as well as heightened short-term mortality in individuals with CVD (11). Sarcopenia diminishes both muscle mass and strength, potentially impairing balance and increasing the risk of falls, consequently increasing the likelihood of hospitalization (21). The reduced activity and prolonged bed rest associated with hospital stays can further exacerbate muscle mass and strength, worsening functional deterioration and increasing the probability of post-discharge falls and readmissions (22). This perpetuating cycle of functional decline and re-hospitalization may contribute to mortality (22). In fact, the pathogenesis of sarcopenia and cardiovascular diseases (CVDs) involves a complex interaction of multiple factors, including malnutrition, physical inactivity, insulin resistance, inflammation, hormonal changes (14). CVDs can exacerbate the adverse outcomes of sarcopenia, such as falls, fractures, hospitalization, and mortality (14). Conversely, sarcopenia significantly contributes to adverse outcomes in older individuals with CVDs. For instance, in patients with coronary heart disease, sarcopenia could predict poor outcomes in elderly patients undergoing percutaneous coronary intervention (PCI). In a study involving 475 elderly patients with coronary artery disease who underwent successful PCI, sarcopenia was assessed by measuring the cross-sectional area of skeletal muscle at the first lumbar vertebra (L1) (23). The findings revealed that 29.7% of patients had a low L1 skeletal muscle index, which independently predicted all-cause mortality and major adverse cardiovascular events (23). Therefore, early identification and diagnosis of sarcopenia in primary care settings and hospitals are vital for initiating preventive or intervention strategies, thus mitigating the risks associated with sarcopenia and reducing the overall healthcare burden and expenses.

Sarcopenia is not merely a reduction in muscle mass but reveals significant implications for functional abilities. This study revealed an association between higher SARC-F scores and poorer functional outcomes. It suggests that individuals with sarcopenia may face challenges related to strength, mobility, and performing daily activities, indicating the importance of assessing this phenomenon clinically. In the African American Health (AAH) cohort, participants with SARC-F scores ≥4 exhibited slower chair stand times and weaker grip strength (5). Similarly, in the NHANES 1999–2006 survey, individuals with SARC-F scores ≥4 demonstrated slower walking times and weaker knee extension strength compared to the control group (5). These findings emphasize the clinical relevance of sarcopenia assessment and underscores the value of tools like SARC-F in recognizing and addressing this condition in elderly populations and those with cardiovascular disease. By identifying individuals at risk of sarcopenia and understanding its impact on functional abilities, healthcare providers can implement appropriate interventions to improve outcomes and quality of life for these individuals.

It is worth noting that this study has some limitations. Firstly, the study was conducted at a single tertiary hospital, which may limit the generalizability of the findings to other settings. Secondly, the responses to the SARC-F questionnaire by some patients may have been influenced by undetected, subtle, transient cognitive impairments associated with their acute condition. Thirdly, the exclusion criteria applied, including acute severe illness and pacemaker implantation, may have inadvertently excluded certain relevant patient populations. Furthermore, the study did not extensively consider potential confounding factors that could influence the association between SARC-F scores and adverse outcomes, such as medication use, socioeconomic status, cognitive function, nutritional status and lifestyle habits. Finally, the study lacked a control group of younger individuals for comparison of SARC-F values between older and younger subjects.

Despite such limitations, the study addresses a gap in the context of dementia and its risk factors among Vietnamese people. This study has major strengths by addressing a gap in the literature regarding the role of the SARC-F questionnaire for predicting risk of adverse outcomes among Vietnamese elderly patients with cardiovascular disease. The study by Shinya Tanaka et al. has indicated that combining physical function measures with the SARC-F questionnaire might enhance predictive accuracy in elderly patients with CVD upon admission. This combined approach did not result in a statistically significant difference when compared to using the SARC-F questionnaire alone (24). These findings suggest that in clinical settings where time constraints limit the feasibility of conducting extensive physical function assessments, the SARC-F questionnaire should be a recommended and practical tool for prognostic evaluation among this patient population.

The study’s findings have important clinical implications. Findings from the study sheds light on the prognostic value of the SARC-F questionnaire in identifying elderly patients at risk of adverse outcomes in the cardiovascular setting. In the context of geriatric cardiovascular care, the study emphasizes the need for comprehensive geriatric assessment tools, such as the SARC-F questionnaire, to identify vulnerable patients who may benefit from tailored interventions and closer monitoring. The SARC-F questionnaire can be easily administered in a clinical setting, making it a valuable tool for identifying elderly CVD patients at a higher risk of adverse outcomes. Early identification of these high-risk patients can help healthcare providers implement appropriate interventions and strategies to improve patient outcomes and reduce the burden of re-hospitalization. Integrating sarcopenia screening into routine cardiovascular evaluations can enhance risk stratification and guide personalized treatment strategies aimed at optimizing outcomes in older adults with cardiovascular conditions. Moreover, raising awareness among healthcare providers about the importance of assessing sarcopenia in elderly patients with cardiovascular disease could facilitate early identification and intervention.

Future prospective studies employing more age groups, larger sample sizes, and a comprehensive panel of risk factors in a multi-center clinical trial can provide further insights into the predictive utility of SARC-F for adverse outcomes in the elderly.

Among elderly patients with CVD, the SARC-F questionnaire is a valuable tool for predicting mortality and the risk of re-hospitalization in elderly patients with cardiovascular disease. A SARC-F score of ≥4 was associated with a significantly higher risk of all-cause death and re-hospitalization. The SARC-F questionnaire offers a simple and cost-effective method for screening and prognostic evaluation in busy clinical settings. The study sheds light on the potential of the SARC-F questionnaire as a screening tool for predicting adverse outcomes in elderly patients with cardiovascular disease. Future multi-center trials with diverse age groups, larger samples, and comprehensive risk factor panels can provide deeper insights into SARC-F’s predictive value for adverse outcomes in older adults.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by Ethical Committee of the University of Medicine and Pharmacy at Ho Chi Minh City (Number: 544/HĐĐĐ-ĐHYD, signed September 22, 2022). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

TaN: Conceptualization, Writing – original draft, Writing – review & editing, Data curation, Investigation, Project administration, Software, Validation. TN (2nd author): Conceptualization, Investigation, Software, Writing – original draft, Writing – review & editing. HC: Data curation, Methodology, Writing – original draft, Writing – review & editing. TN (4th author): Supervision, Writing – original draft, Writing – review & editing. TrN: Formal analysis, Project administration, Writing – original draft, Writing – review & editing. DD: Project administration, Validation, Writing – original draft, Writing – review & editing. TL: Validation, Writing – original draft, Writing – review & editing.