© 2019, Asian Association for Frailty and Sarcopenia and Taiwan Association for Integrated Care. Background/Purpose: The purpose of this study was two-fold. The first was to examine the predictors of cardiac events including sarcopenia in elderly patients with heart failure (HF) and second, to determine whether the predictors of cardiac events differed between HF patients with and without any physical symptoms. Methods: This 8-month prospective cohort study followed 191 outpatients of the Cardiovascular Medicine Department of our institution. These patients were aged 60 years and older, and had previously been admitted to hospital for the management of HF or were currently receiving pharmacological treatment for HF. The outcome measure was a cardiac event, which included cardiac death or HF-related hospitalization within an 8-month period. We measured the following as risk factors for cardiac events: age, sex, body mass index, sarcopenia, plasma brain natriuretic peptide levels, estimated glomerular filtration rate, self-care behavior, and depressive symptoms. Sarcopenia was identified using the algorithm developed by the Asian Working Group for Sarcopenia. We used the New York Heart Association (NYHA) classification to stratify patients into either the NYHA class I group (n=99) or the NYHA classes II-IV group (n=92). Results: During the follow-up period, there were 20 (10.5%) cardiac events. Twenty patients (10.5%) had sarcopenia. Multivariate Cox proportional hazard analysis revealed that sarcopenia was significantly associated with cardiac events only in the NYHA II-IV group (hazard ratio 4.44; 95% confidence interval 1.09-18.14; P=0.04) after adjustment for sex, BNP, and eGFR. Conclusions: Sarcopenia predicts cardiac events in patients with NYHA IIIV HF.