Understanding Cardiac Cachexia among Patients with Heart Failure Using a Mixed-Methods Sequential Explanatory Design

Abstract

In heart failure, cardiac cachexia often presents in people as weight loss accompanied by muscle wastage, loss of appetite and reduced quality of life. Such people often have a poor prognosis. However, the impact of these symptoms on Thai patients’ quality of life is unknown. Therefore, this study aimed to explore cardiac cachexia, its symptoms, and its effect on quality of life using a mixed-method sequential explanatory design. Data for this study were collected from a specific cardiac failure clinic in a large hospital in Bangkok, Thailand, from August 2022 to January 2023. Forty-two patients with heart failure were screened for cardiac cachexia using cachexia consensus criteria and bioelectrical impedance vector analysis. They also completed the Simplified Nutritional Appetite Questionnaire, the Thirst Distress Scale for Heart Failure and the Kansas City Cardiomyopathy Questionnaire to assess appetite, thirst, and quality of life, respectively. Thirty-eight participants were included for statistical analysis and divided into two groups: those with confirmed or suspected cardiac cachexia (n = 7) and those without (n = 31). The former group reported low appetite scores; however, no significant differences were observed between the two groups’ appetite, thirst, or quality of life. After identifying patients with cardiac cachexia, six semi-structured interviews were conducted using an interview guide and analyzed through thematic analysis. The interviews revealed two common themes: Changes in diet and thirst and a Reduction in physical activity levels. Both themes complement the quantitative results. This study initiates a significant step in the understanding of cardiac cachexia in the Thai population with heart failure. Nurses can play a crucial role in identifying and managing patients with or at risk of cardiac cachexia.