{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:12:21Z","timestamp":1787008341571,"version":"build-2736575974"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Universal muscle health cut-offs for older patients with heart failure often overlook age- and sex-specific biological heterogeneity, potentially compromising prognostic accuracy. We aimed to develop and validate age- and sex-specific cut-off values for muscle health metrics to enhance prognostic performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>From a nationwide, multicenter cohort registry, 9693 patients aged \u226565\u00a0years hospitalised for heart failure were analysed. We assessed five muscle health metrics (arm and calf circumference, handgrip strength, gait speed and Short Physical Performance Battery) and derived age- and sex-specific cut-off values for predicting 1-year all-cause mortality across three age groups (65\u201374, 75\u201384, 85+ years). Age- and sex-specific thresholds varied substantially across demographics (e.g. handgrip strength: 24.5\u201319.6\u00a0kg in men and 16.6\u201311.6\u00a0kg in women from the youngest to the oldest group) and showed robust prognostic associations with mortality (adjusted hazard ratio: 1.44\u20133.25, all P\u00a0&amp;lt;\u2009.001). Importantly, age- and sex-specific cut-offs consistently outperformed fixed criteria by Asian Working Group for Sarcopenia in 2019, evidenced by substantial improvements in Akaike information criterion that ranged from 8.1 to 119.4, continuous net reclassification improvement (0.050 to 0.342), and integrated discrimination improvement (0.002 to 0.023) across four metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Age- and sex-specific muscle health thresholds offer superior prognostic accuracy over universal fixed values in older patients with heart failure, evidenced by substantial improvements in model fit, reclassification and discrimination. This individualised approach enables more precise risk stratification and supports the transition toward personalised assessment in geriatric heart failure care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data source registration<\/jats:title>\n                    <jats:p>University Hospital Medical Information Network Clinical Trials Registry, URL: https:\/\/center6.umin.ac.jp\/cgi-open-bin\/ctr\/ctr_view.cgi?recptno=R000054579, Registration number: UMIN000047893.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afag034","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T12:41:53Z","timestamp":1770295313000},"source":"Crossref","is-referenced-by-count":2,"title":["Age- and sex-specific muscle health cut-offs improve prognostic accuracy in older patients with heart failure: a secondary analysis of a nationwide, multicenter cohort registry"],"prefix":"10.1093","volume":"55","author":[{"given":"Yasuhiro","family":"Miki","sequence":"first","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2562-1685","authenticated-orcid":false,"given":"Satoshi","family":"Katano","sequence":"additional","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Nakagama","sequence":"additional","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Iwata","sequence":"additional","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Kono","sequence":"additional","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Sakurada","sequence":"additional","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Morisawa","sequence":"additional","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"2026022013275529800_ref1","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.jacasi.2024.01.013","article-title":"Epidemiology and burden of heart failure in Asia","volume":"4","author":"Feng","year":"2024","journal-title":"JACC Asia"},{"key":"2026022013275529800_ref2","doi-asserted-by":"crossref","first-page":"105933","DOI":"10.1016\/j.archger.2025.105933","article-title":"Determinant of functional independence in older patients with heart failure: physical function vs. muscle mass","volume":"137","author":"Honma","year":"2025","journal-title":"Arch Gerontol Geriatr"},{"key":"2026022013275529800_ref3","doi-asserted-by":"crossref","first-page":"100434","DOI":"10.1016\/j.jnha.2024.100434","article-title":"Prognostic implication of sarcopenia diagnosed by updated Asian working Group for Sarcopenia criteria in older patients with heart failure: utility and limitation","volume":"29","author":"Katano","year":"2025","journal-title":"J Nutr Health Aging"},{"key":"2026022013275529800_ref4","doi-asserted-by":"crossref","first-page":"6549","DOI":"10.3390\/ijms21186549","article-title":"Muscle wasting and sarcopenia in heart failure\u2014the current state of science","volume":"21","author":"Lena","year":"2020","journal-title":"Int J Mol Sci"},{"key":"2026022013275529800_ref5","doi-asserted-by":"crossref","first-page":"e007198","DOI":"10.1161\/CIRCHEARTFAILURE.120.007198","article-title":"Skeletal muscle function, structure, and metabolism in patients with heart failure with reduced ejection fraction and heart failure with preserved ejection fraction","volume":"13","author":"Bekfani","year":"2020","journal-title":"Circ Heart Fail"},{"key":"2026022013275529800_ref6","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/s10741-022-10219-9","article-title":"Skeletal muscle abnormalities in heart failure with preserved ejection fraction","volume":"28","author":"Md","year":"2023","journal-title":"Heart Fail Rev"},{"key":"2026022013275529800_ref7","doi-asserted-by":"crossref","first-page":"1599572","DOI":"10.3389\/fmed.2025.1599572","article-title":"Sarcopenia defined by multidimensional factors and its prognostic role in heart failure: a systematic review and meta-analysis","volume":"12","author":"Lu","year":"2025","journal-title":"Front Med"},{"key":"2026022013275529800_ref8","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1007\/s00392-023-02360-8","article-title":"Are sarcopenia and its individual components linked to all-cause mortality in heart failure? A systematic review and meta-analysis","volume":"114","author":"Prokopidis","year":"2025","journal-title":"Clin Res Cardiol"},{"key":"2026022013275529800_ref9","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"2026022013275529800_ref10","doi-asserted-by":"publisher","first-page":"2164","DOI":"10.1038\/s43587-025-01004-y","article-title":"A focus shift from sarcopenia to muscle health in the Asian working Group for Sarcopenia 2025 consensus update","volume":"5","author":"Chen","year":"2025","journal-title":"Nat Aging"},{"key":"2026022013275529800_ref11","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1007\/s11357-023-00750-4","article-title":"Sex differences in skeletal muscle-aging trajectory: Same processes, but with a different ranking","volume":"45","author":"de Jong","year":"2023","journal-title":"GeroScience"},{"key":"2026022013275529800_ref12","doi-asserted-by":"crossref","first-page":"4651","DOI":"10.3390\/ijms24054651","article-title":"Sex differences in inflammation and muscle wasting in aging and disease","volume":"24","author":"Peruta","year":"2023","journal-title":"Int J Mol Sci"},{"key":"2026022013275529800_ref13","doi-asserted-by":"crossref","first-page":"e011471","DOI":"10.1161\/CIRCHEARTFAILURE.123.011471","article-title":"Sex differences in skeletal muscle pathology in patients with heart failure and reduced ejection fraction","volume":"17","author":"Wood","year":"2024","journal-title":"Circ Heart Fail"},{"key":"2026022013275529800_ref14","doi-asserted-by":"crossref","first-page":"e13731","DOI":"10.1002\/jcsm.13731","article-title":"Mapping normative muscle health metrics across the aging continuum: a multinational study pooling data from eight cohorts in Japan, Malaysia and Taiwan","volume":"16","author":"Chen","year":"2025","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"2026022013275529800_ref15","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1002\/ca.24091","article-title":"Sex differences in skeletal muscle fiber types: a meta-analysis","volume":"37","author":"Nuzzo","year":"2024","journal-title":"Clin Anat"},{"key":"2026022013275529800_ref16","doi-asserted-by":"crossref","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission","volume":"49","author":"Guralnik","year":"1994","journal-title":"J Gerontol"},{"key":"2026022013275529800_ref17","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1253\/circj.CJ-22-0032","article-title":"New conversion formula between B-type natriuretic peptide and N-terminal-pro-B-type natriuretic peptide\u2014analysis from a multicenter study","volume":"86","author":"Ishihara","year":"2022","journal-title":"Circ J"},{"key":"2026022013275529800_ref18","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1253\/circj.CJ-23-0722","article-title":"Incidence of hospitalization-associated disability in older patients with heart failure","volume":"88","author":"Takahashi","year":"2024","journal-title":"Circ J"},{"key":"2026022013275529800_ref19","doi-asserted-by":"crossref","first-page":"105549","DOI":"10.1016\/j.jamda.2025.105549","article-title":"Hospitalization-associated disability and 1-year mortality risk in older patients with heart failure","volume":"26","author":"Kato","year":"2025","journal-title":"J Am Med Dir Assoc"},{"key":"2026022013275529800_ref20","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1253\/circrep.CR-24-0058","article-title":"Real-world evidence of feasible assessment and intervention in cardiovascular physical therapy for older patients with heart failure\u2014insight from the J-proof HF of the Japanese society of cardiovascular physical therapy","volume":"6","author":"Kono","year":"2024","journal-title":"Circ Rep"},{"key":"2026022013275529800_ref21","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1111\/ggi.12397","article-title":"English translation of the Kihon checklist","volume":"15","author":"Arai","year":"2015","journal-title":"Geriatr Gerontol Int"},{"key":"2026022013275529800_ref22","first-page":"1322","article-title":"Missing data in clinical research: a tutorial on multiple imputation","volume":"37","author":"Austin","year":"2020","journal-title":"Can J Cardiol"},{"key":"2026022013275529800_ref23","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: revised European consensus on definition and diagnosis","volume":"48","author":"Cruz-Jentoft","year":"2018","journal-title":"Age Ageing"},{"key":"2026022013275529800_ref24","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.jchf.2015.11.010","article-title":"Complementary role of arm circumference to body mass index in risk stratification in heart failure","volume":"4","author":"Kamiya","year":"2016","journal-title":"JACC Heart Fail"},{"key":"2026022013275529800_ref25","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.1016\/j.cjca.2023.08.006","article-title":"Prognostic utility of skeletal muscle mass metrics in patients with heart failure","volume":"39","author":"Uchida","year":"2023","journal-title":"Can J Cardiol"},{"key":"2026022013275529800_ref26","doi-asserted-by":"crossref","first-page":"597675","DOI":"10.3389\/fphys.2020.597675","article-title":"Inflammation and skeletal muscle wasting during cachexia","volume":"11","author":"Webster","year":"2020","journal-title":"Front Physiol"},{"key":"2026022013275529800_ref27","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/sim.2929","article-title":"Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond","volume":"27","author":"Pencina","year":"2008","journal-title":"Stat Med"},{"key":"2026022013275529800_ref28","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1002\/sim.4085","article-title":"Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers","volume":"30","author":"Pencina","year":"2011","journal-title":"Stat Med"},{"key":"2026022013275529800_ref29","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/b97636","volume-title":"Model Selection and Multimodel Inference: A Practical Information-Theoretic Approach","author":"Burnham","year":"2002","edition":"2nd"},{"key":"2026022013275529800_ref30","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1253\/circj.CJ-19-0241","article-title":"Nationwide survey of multidisciplinary care and cardiac rehabilitation for patients with heart failure in Japan\u2014An analysis of the AMED-CHF study","volume":"83","author":"Kamiya","year":"2019","journal-title":"Circ J"},{"key":"2026022013275529800_ref31","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1253\/circj.CJ-25-0002","article-title":"JCS\/JHFS 2025 guideline on diagnosis and treatment of heart failure","volume":"89","author":"Kitai","year":"2025","journal-title":"Circ J"},{"key":"2026022013275529800_ref32","doi-asserted-by":"publisher","first-page":"3097","DOI":"10.1007\/s40520-023-02614-5","article-title":"Do lifestyle, anthropometric and demographic factors associated with muscle strength differ in a UK and Japanese cohort? An exploratory analysis","volume":"35","author":"Dennison","year":"2023","journal-title":"Aging Clin Exp Res"},{"key":"2026022013275529800_ref33","doi-asserted-by":"publisher","first-page":"2338","DOI":"10.1016\/j.clnu.2023.10.004","article-title":"Sodium-glucose co-transporter 2 inhibitors and sarcopenia: a controversy that must be solved","volume":"42","author":"Afsar","year":"2023","journal-title":"Clin Nutr"},{"key":"2026022013275529800_ref34","doi-asserted-by":"crossref","first-page":"106420","DOI":"10.1016\/j.ejim.2025.07.016","article-title":"Effect of sodium-glucose cotransporter-2 inhibitors on skeletal muscle","volume":"141","author":"St\u00f6llberger","year":"2025","journal-title":"Eur J Intern Med"},{"key":"2026022013275529800_ref35","doi-asserted-by":"crossref","first-page":"M3","DOI":"10.1093\/gerona\/54.1.M3","article-title":"Are performance-based measures sufficiently reliable for use in multicenter trials?","volume":"54","author":"Jette","year":"1999","journal-title":"J Gerontol A Biol Sci Med Sci"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/55\/2\/afag034\/67024640\/afag034.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/55\/2\/afag034\/67024640\/afag034.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T18:28:05Z","timestamp":1771612085000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afag034\/8493248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,1]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afag034","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,2,1]]},"article-number":"afag034"}}