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

Chronic heart failure (CHF) is characterized by reduced peak oxygen consumption (VO_2peak). Cachexia may exacerbate the decline in VO_2peak from reductions in muscle mass and strength. We sought to assess differences in VO_2peak 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 VO_2peak 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, I² = 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, I² = 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 VO_2peak compared to their free-cachexia counterparts.