- •Frailty is common in patients with heart failure and is associated with worse outcomes.
- •Grip strength is a simple, standardized way of measuring frailty.
- •Decreases in grip strength are associated with worse survival rates and quality of life.
- •Grip strength may help to select patients most likely to benefit from certain therapies.
Frailty is prevalent among patients with heart failure (HF) and is associated with increased mortality rates and worse patient-centered outcomes. Hand grip strength (GS) has been proposed as a single-item marker of frailty and a potential screening tool to identify patients most likely to benefit from therapies that target frailty so as to improve quality of life (QoL) and clinical outcomes. We assessed the association of longitudinal decline in GS with all-cause mortality and QoL. Decline in GS is associated with increased risk of all-cause mortality and worse overall and domain-specific (physical, functional, emotional, social) QoL among patients with advanced HF.
We used data from a prospective, observational cohort of patients with New York Heart Association class III or IV HF in Singapore. Patients’ overall and domain-specific QoL were assessed, and GS was measured every 4 months. We constructed a Kaplan-Meier plot with GS at baseline dichotomized into categories of weak (≤ 5th percentile) and normal (> 5th percentile) based on the GS in a healthy Singapore population of the same sex and age. Missing GS measurements were imputed using chained equations. We jointly modeled longitudinal GS measurements and survival time, adjusting for comorbidities. We used mixed effects models to evaluate the associations between GS and QoL.
Among 251 patients (mean age 66.5 ± 12.0 years; 28.3% female), all-cause mortality occurred in 58 (23.1%) patients over a mean follow-up duration of 3.0 ± 1.3 years. Patients with weak GS had decreased survival rates compared to those with normal GS (log-rank P = 0.033). In the joint model of longitudinal GS and survival time, a decrease of 1 unit in GS was associated with a 12% increase in rate of mortality (hazard ratio: 1.12; 95% confidence interval: 1.05–1.20; P = < 0.001). Higher GS was associated with higher overall QoL (β (SE) = 0.36 (0.07); P = < 0.001) and higher domain-specific QoL, including physical (β [SE] = 0.13 [0.03]; P = < 0.001), functional (β [SE] = 0.12 [0.03]; P = < 0.001), and emotional QoL (β [SE] = 0.08 [0.02]; P = < 0.001). Higher GS was associated with higher social QoL, but this was not statistically significant (β [SE] = 0.04 [0.03]; P = 0.122).
Among patients with advanced HF, longitudinal decline in GS was associated with worse survival rates and QoL. Further studies are needed to evaluate whether incorporating GS into patient selection for HF therapies leads to improved survival rates and patient-centered outcomes.
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Published online: December 13, 2022
Accepted: November 8, 2022
Received in revised form: October 25, 2022
Received: April 22, 2022
Publication stageIn Press Journal Pre-Proof
© 2022 Elsevier Inc. All rights reserved.
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- Quantifying the eyeball test: grip strength at the nexus of frailty, cachexia and sarcopenia in heart failureJournal of Cardiac Failure
- Preview“I know it when I see it...” – This famous phrase, written by Supreme Court Justice Potter Stewart in his concurrence to the majority decision in Jacobellis vs. Ohio in 1964, has a well-known parallel in clinical medicine: the “eyeball” test. Perhaps nowhere in cardiovascular medicine is the eyeball test more widely applied than in the assessment of frailty, a clinical entity marked by changes in physiologic and cognitive function that leaves an individual more susceptible to adverse outcomes in response to stress.