With populations aging rapidly worldwide, heart failure has become one of the most pressing medical and social challenges. Older patients face not only a high mortality risk but also losses in muscle strength, mobility, and independence. Clinicians frequently see people who, despite optimal cardiac care, still struggle with frailty and declining physical performance. Until now, different groups have proposed their own criteria: the AWGS criteria developed mainly by Asian experts, the EWGSOP criteria from Europe, and the SDOC statement from the United States. As a result, three different definitions and diagnostic methods have coexisted, creating a lack of consistency worldwide. Recognizing the need for a global standard, leading experts from these groups came together to form the Global Leadership Initiative on Sarcopenia (GLIS). The GLIS model introduced a new diagnostic approach based on muscle strength, muscle mass, and muscle-specific strength, while reclassifying physical performance tests such as the Short Physical Performance Battery (SPPB) not as diagnostic criteria but as outcomes of sarcopenia. However, it had remained unclear whether this new GLIS model could reliably predict prognosis in older patients with heart failure, or whether it truly reflects declines in physical performance.
Researchers from Juntendo University, Japan, led by Dr. Taisuke Nakade, together with Dr. Daichi Maeda, Dr. Yuya Matsue, Dr. Tohru Minamino, and colleagues from multiple hospitals and universities across Japan, have offered a solution to this puzzle. Their study, published in the European Journal of Preventive Cardiology on October 4, 2025, provides the first worldwide validation of the new GLIS model in older patients with heart failure.
“ Our inspiration was to test whether this new model truly reflects what clinicians observe at the bedside—namely, functional decline and poor prognosis in older patients with heart failure—and to generate evidence that could influence both practice and international guidelines ,” Dr. Nakade explains.
The GLIS model focuses on three core measures—muscle mass, grip strength, and muscle-specific strength—while treating walking speed and other functional tests as outcomes, thus separating diagnosis from performance. The study analyzed 891 patients aged 65 or older from the FRAGILE-HF registry, classifying them as non-sarcopenic, possible sarcopenic, or sarcopenic. Physical performance was assessed using walking speed, the five-chair stand test, the SPPB, and the six-minute walk test. Patients with sarcopenia or possible sarcopenia showed significantly worse performance across all measures.
Importantly, the GLIS model accurately identified patients with decreased physical performance. Over two years, mortality increased stepwise from non-sarcopenic to possible sarcopenic to sarcopenic patients. Even after adjusting for other risk factors, GLIS-defined sarcopenia was independently associated with a 3.4-fold higher risk of death. Compared to the conventional AWGS2019 criteria, GLIS provided superior risk reclassification, making it a more powerful tool for clinical decision-making.
The implications are clear. By diagnosing sarcopenia more accurately, clinicians can better identify those at high risk of physical decline and poor outcomes, even before symptoms become severe. The model also strengthens treatment planning, discharge decisions, and long-term care strategies. At a broader level, validating GLIS supports international standardization of sarcopenia diagnosis, promoting equitable care and paving the way for new diagnostic tools, screening devices, and digital health applications.
As Dr. Nakade emphasizes, “ This study showed that the newly proposed international GLIS model for sarcopenia effectively reflects both impaired physical performance and poor prognosis in older patients with heart failure .”
In short, the GLIS model gives doctors a practical, evidence-based approach to detect sarcopenia early, improve patient outcomes, and address one of the most urgent challenges in aging societies.
Reference
Authors
Taisuke Nakade 1 , Daichi Maeda 1,2 , Yuya Matsue 1 , Nobuyuki Kagiyama 1,3 , Yudai Fujimoto 1 , Tsutomu Sunayama 1 , Taishi Dotare 1 , Kentaro Jujo 4 , Kazuya Saito 5 , Kentaro Kamiya 6 , Hiroshi Saito 7 , Yuki Ogasahara 8 , Emi Maekawa 9 , Masaaki Konishi 10 , Takeshi Kitai 11 , Kentaro Iwata 12 , Hiroshi Wada 13 , Takatoshi Kasai 1,14 , Hirofumi Nagamatsu 15 , Shin-ichi Momomura 16 , and Tohru Minamino 1
Title of original paper
Prognostic Utility of the Global Leadership Initiative on Sarcopenia Model in Older Patients with Heart Failure: Post-Hoc Analysis of the FRAGILE-HF Study
Journal
European Journal of Preventive Cardiology
DOI
Affiliations
1 Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
2 Department of Cardiology, Hirakata City Hospital, Osaka, Japan
3 Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
4 Department of Cardiology, Nishiarai Heart Centre Hospital, Tokyo, Japan
5 Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
6 Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
7 Department of Rehabilitation, Kameda Medical Centre, Kamogawa, Japan
8 Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
9 Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
10 Division of Cardiology, Yokohama City University Medical Centre, Yokohama, Japan
11 Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan
12 Department of Rehabilitation, Kobe City Medical Centre General Hospital, Kobe, Japan
13 Department of Cardiovascular Medicine, Saitama Medical Centre, Jichi Medical University, Saitama, Japan
14 Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
15 Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
16 Saitama Citizens Medical Centre, Saitama, Japan
About Dr. Taisuke Nakade from Juntendo University
Dr. Taisuke Nakade is a Doctor of Medicine in the Department of Cardiovascular Biology and Medicine at the Juntendo University Graduate School of Medicine, Japan. He specializes in cardiology and geriatric medicine, with a focus on heart failure, sarcopenia, and frailty in older adults. His research also explores exercise-based cardiac rehabilitation, and he has published more than 15 articles in these areas. Dr. Nakade actively collaborates with multidisciplinary teams and is a member of leading professional societies, including the European Society of Cardiology (ESC) and its Heart Failure Association (HFA).
Observational study
People
4-Oct-2025
Nobuyuki Kagiyama is affiliated with a department funded by Paramount Bed Co., Ltd. through collaborative research agreements and has received honoraria from Novartis Japan, Otsuka Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Eli Lilly Japan K.K., AstraZeneca, AMI Inc., and EchoNous. Kentaro Kamiya has received funding outside the submitted work from Eiken Chemical Co., Ltd. and SoftBank Corp., Ltd. Takatoshi Kasai is affiliated with a department sponsored by Philips, ResMed, and Fukuda Denshi. Yuya Matsue has received honoraria from Otsuka Pharmaceutical Co., Ltd., EN Otsuka Pharmaceutical Co., Ltd., Novartis Pharma K.K., Bayer Inc., and AstraZeneca, and has received a collaborative research grant from Pfizer Japan Inc., Otsuka Pharmaceutical Co., Ltd., EN Otsuka Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Roche Diagnostics International Ltd., and Roche Diagnostics K.K.