COMMENTARY

Cardiac Cachexia: Assessment and Management

Betty R. Ferrell, PhD, RN

Disclosures

March 18, 2014

Managing the Effects of Cardiac Cachexia

Carlson H, Dahlin CM
J Hosp Palliat Nurs. 2014;16:15-20

Article Summary

Cachexia is common in cancer, yet it is poorly understood in noncancer diagnoses. In this article, Carlson and Dahlin review cancer cachexia in cardiac disease. The definition, pathophysiology, and assessment specific to cardiac disease are described, as well as diagnostic work-up and pharmacologic and nonpharmacologic interventions.

Cardiac cachexia is defined as "a complex metabolic disorder involving progressive weight loss accompanied by muscle wasting, fatigue, and weakness." The weight loss involves the loss of lean muscle mass as well as fat and bone. Once cachexia occurs, it is impossible to reverse the muscle wasting by increasing caloric intake alone.[1,2,3,4,5]

Some of the key issues addressed in this article include the following:

  • More than 80% of patients with advanced noncancer illnesses develop cachexia;

  • 10%-15% of patients with advanced congestive heart failure develop severe weight loss, and two thirds develop muscle wasting; and

  • Patients with cardiac cachexia have a 50% mortality rate in 18 months.

The article emphasizes that management of cardiac cachexia must be interdisciplinary. Other disciplines described as helpful in addressing cardiac cachexia include social workers, who can focus on the family members' roles in supporting feeding. Rehabilitation services and nursing are also critical in addressing patient and caregiver concerns.

A key aspect of management is energy conservation, and maximizing calorie and protein intake while participating in strength-building exercises. Consultation with a cardiac nutritionist may also be helpful.

The authors also discuss use of megestrol acetate (Megace®) or corticosteroids to stimulate appetite and prevent nausea. Other pharmacologic options are discussed, including pros and cons of various approaches.

Tools recommended for patient assessment include the Edmonton Symptom Assessment Scale[4] or the Simplified Nutritional Appetite Questionnaire.[5]

Viewpoint

This case-based article addresses an important palliative care concern. It brings attention to an understudied area of cardiac cachexia and offers insight into the pathophysiology of cachexia, and its effects on other symptoms and quality of life.

This article is an excellent overview of cardiac cachexia that offers both an understanding of the symptom as well as practical suggestions for assessment and management. As is the case for many other symptoms in advanced disease, cachexia leads to a cascade of other concerns, such as nausea, constipation, altered taste, depression, weakness, and fatigue. Each of these symptoms can then lead to a cycle in which each one potentially affects the others; combined with the progressive underlying disease, the cycle is difficult to stop.

This article provides a very comprehensive review of the problem of cardiac cachexia, and a case study is included to illustrate each of these aspects of care.

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