2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.

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Sarcopenia: European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People

ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation

/pdf/2016-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-z18hg30pp1.pdf

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

/pdf/2016-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-53v7yllhiz.pdf

Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

/pdf/sarcopenia-revised-european-consensus-on-definition-and-4bp7en4cxo.pdf

Sarcopenia: Revised European consensus on definition and diagnosis

DOI:10.1097/SPC.0000000000000297 What does the future hold for treating weight loss in advanced cancer patients? The past 5 years have yielded immense disappointment in efforts to treat the cancer-associated weight loss syndrome. As reviewed by Garcia (pp. 266–271) in this issue of Current Opinions in Supportive and Palliative Care, two large registration trials, which, in total, included over 1500 patients and cost an estimated $100 million, failed to achieve their primary dual endpoints [1,2]. Neither of these trials – one which tested the selective androgen receptor modulator, enobosarm, and the other which tested the oral ghrelin mimetic, anamorelin – resulted in a prescribable agent, leading to the same stagnant conclusion that modest palliation with older agents, such as progesterones and corticosteroids, remains the only proven therapeutic approach for select weight-losing cancer patients with an incurable malignancy [3,4]. For example, in the anamorelin trials, it was an absence of improvement in hand grip strength that led to disappointment. In essence, over the past 4 decades, the standard of care for treating cancer-associated weight loss in incurable cancer patients remains unchanged. Hence, the question posed above is not only provocative but also relevant and timely. In this issue of the journal, investigators begin to ponder this question further. Summarizing a compendium of previously published data, Lau and Iyengar (pp. 261–265) take the novel approach of focusing on weight loss in cancer patients who are receiving radiation. Only recently, Fakhry et al. [5] added yet another such study that looks at radiation in over 600 patients with oropharyngeal cancer and observed that weight loss is associated with shorter cancer progression-free survival. Such studies join countless others that have reached the exact same conclusion: weight loss in cancer patients is associated with poor clinical outcomes. However, this focus on radiation-treated cancer patients is innovative; it draws attention to cancer patients who often receive aggressive multimodality therapy, suffer high rates of severe weight loss, and yet appear to be a captive audience for a therapeutic intervention to help manage weight loss because of daily travel to the clinic to receive radiation treatments.

/pdf/cancer-associated-weight-loss-releasing-its-firm-grip-on-1pshshzs5z.pdf

Cancer-associated weight loss: releasing its firm grip on negative clinical outcomes.

Wanted--and Needed--more studies in geriatric lung cancer patients.

More than 400,000 cancer patients in the USA contend with bone metastases on an annual basis. These patients often suffer pain, a decline in quality of life, and a shortened survival. As a result, over the past several years, efforts to enhance bone integrity in patients with osseus metastases have become a major research priority. This review discusses the evolving role of bisphosphonates and their side effects, highlights other pharmacological interventions aimed at enhancing bone integrity, and reviews other pragmatic approaches to prevent worsening pain and fractures, as derived from a single institution case series of patients with problematic rib metastases.

Aminah Jatoi

Papers

Cancer-associated weight loss: releasing its firm grip on negative clinical outcomes.

Wanted--and Needed--more studies in geriatric lung cancer patients.

Osseous metastases: drugs that enhance bone integrity and prevent adverse skeletal events

Integrative nutritional approaches to loss of weight and appetite in patients with advanced cancer

STEPP for the EGFR inhibitor-induced rash-definitely a step in the right direction