The study provides the first global validation of the new GLIS model in elderly patients with heart failure

With populations aging rapidly worldwide, heart failure has become one of the most pressing medical and societal challenges. Elderly patients face not only a high risk of mortality but also losses in muscle strength, mobility and independence. Clinicians often see individuals who, despite optimal cardiac care, still struggle with weakness and reduced 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 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 Sarcopenia Leadership Initiative (GLIS). The GLIS model introduced a new diagnostic approach based on muscle strength, muscle mass and muscle power, while reclassifying physical performance tests such as the Short Physical Performance Battery (SPPB) not as diagnostic criteria but as outcomes of sarcopenia. However, it remained unclear whether this new GLIS model could reliably predict prognosis in elderly HF patients or whether it truly reflects declines in physical performance.

Researchers from Japan’s Juntendo University, led by Dr. Taisuke Nakade, along with Drs. Daichi Maeda, Dr. Yuya Matsue, Dr. Tohru Minamino and colleagues from several hospitals and universities across Japan have provided a solution to this puzzle. Their study, published in European Journal of Preventive Cardiology on October 4, 2025, provides the first global validation of the new GLIS model in elderly patients with heart failure.

“Our inspiration was to test whether this new model truly reflects what clinicians observe at the bedside—that is, functional decline and poor prognosis in elderly patients with heart failure—and to generate evidence that could influence both practice and international guidelines.,” explains Dr. Nakade.

The GLIS model focuses on three key measures—muscle mass, grip strength, and muscle strength—while treating walking speed and other functional tests as outcomes, thus separating diagnosis from performance. The study analyzed 891 patients aged 65 years and older from the FRAGILE-HF registry, classifying them as non-sarcopenic, probable sarcopenic or sarcopenic. Physical performance was assessed using walking speed, the five-chair test, the SPPB, and the six-minute walk test. Patients with sarcopenia or probable sarcopenia performed significantly worse on all measures.

Importantly, the GLIS model accurately identified patients with impaired physical performance. Over two years, mortality increased gradually from non-sarcopenic to probable 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 with 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 impairment and poor outcome, even before symptoms become severe. The model also supports treatment planning, discharge decisions, and long-term care strategies. More broadly, GLIS validation supports the 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 demonstrated that the recently proposed GLIS international model for sarcopenia effectively reflects both reduced physical performance and poor prognosis in elderly HF patients.”

In summary, the GLIS model provides physicians with a practical, evidence-based approach to early detection of sarcopenia, improving patient outcomes, and addressing one of the most pressing challenges in aging societies.