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Canadian Journal of Cardiology

Prognostic Value of Handgrip Strength in Older Adults Undergoing Cardiac Surgery

Published:August 28, 2021DOI:https://doi.org/10.1016/j.cjca.2021.08.016

      Abstract

      Background

      Although multidimensional frailty scales have been proven to predict mortality and morbidity in cardiac surgery, there is a need for rapid tools that could be easily administered at the point of care. Handgrip strength (HGS) is an attractive option that can be measured in acutely ill and bed-bound patients, although it has yet to be validated in a large cardiac surgery cohort.

      Methods

      This is a post hoc analysis of a multicentre prospective study in older patients undergoing coronary artery bypass grafting and/or valve surgery from 2011 to 2019. HGS was measured before surgery and classified by sex-stratified cutoffs. The primary outcome was 1-year mortality and secondary outcomes were 30-day mortality, discharge disposition, and prolonged length of stay.

      Results

      There were 1245 patients included in the analysis (mean age 74.0 ± 6.6 years; 30% female). Weak HGS was associated with advanced age, heart failure, kidney disease, malnutrition, and various frailty scales. In those with weak vs normal HGS, respectively, 1-year mortality was 17% vs 6%, 30-day mortality was 10% vs 3%, prolonged length of stay was 34% vs 19%, and discharge to a health care facility was 45% vs 26% (all P < 0.001). After adjustment, HGS was predictive of 1-year and 30-day mortalities, with odds ratios of 2.44 (95% confidence interval [CI] 1.39-4.29) and 2.83 (1.38-5.81), respectively. HGS cutoffs of < 26 kg in men and < 16 kg in women had the highest predictive performance.

      Conclusions

      HGS is a simple and effective tool to identify patients at higher risk of mortality and protracted recovery after cardiac surgery.

      Résumé

      Contexte

      Bien qu’il ait été démontré que les échelles de fragilité multidimensionnelles permettent de prédire la mortalité et la morbidité associées à la chirurgie cardiaque, il est nécessaire de disposer d’outils rapides qui pourraient être facilement utilisés au lieu d’intervention. La force de préhension (FdP) est une option intéressante; elle peut être mesurée chez les patients gravement malades et alités, même si elle doit encore être confirmée avec une grande cohorte de patients en chirurgie cardiaque.

      Méthodologie

      Il s’agit d’une analyse a posteriori d’une étude pros-pective multicentrique chez des patients âgés ayant subi un pontage aortocoronarien et/ou une chirurgie valvulaire entre 2011 et 2019. La FdP a été mesurée avant la chirurgie et classée selon des seuils stratifiés par sexe. Le paramètre d’évaluation principal était la mortalité à un an et les paramètres d’évaluation secondaires étaient la mortalité à 30 jours, l’état au moment du congé et la durée prolongée du séjour.

      Résultats

      L’analyse a porté sur 1 245 patients (âge moyen : 74,0 ± 6,6 ans; 30 % de femmes). Une FdP peu élevée était associée à l’âge avancé, à l’insuffisance cardiaque, aux maladies rénales, à la malnutrition et à diverses échelles de fragilité. Chez les patients présentant une FdP peu élevée ou normale, respectivement, la mortalité à un an était de 17 % vs 6 %, la mortalité à 30 jours, de 10 % vs 3 %, la durée prolongée du séjour, de 34 % vs 19 % et l’admission dans un établissement de soins de santé après le congé, de 45 % vs 26 % (tous les p < 0,001). Après ajustement, la FdP était un facteur prédictif de la mortalité à un an et à 30 jours, avec un rapport de cotes de 2,44 (intervalle de confiance [IC] à 95 % : 1,39-4,29) et de 2,83 (IC à 95 % : 1,38-5,81), respectivement. Les seuils de FdP de < 26 kg chez les hommes et de < 16 kg chez les femmes étaient ceux qui offraient le meilleur pouvoir prédictif.

      Conclusions

      La FdP est un outil simple et efficace pour cibler les patients qui présentent un risque plus élevé de mortalité et de récupération lente après une chirurgie cardiaque.
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      References

        • Shahian D.M.
        • O’Brien S.M.
        • Filardo G.
        • et al.
        The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1—coronary artery bypass grafting surgery.
        Ann Thorac Surg. 2009; 88: S2-S22
        • Geissler H.J.
        • Hölzl P.
        • Marohl S.
        • et al.
        Risk stratification in heart surgery: comparison of six score systems.
        Eur J Cardiothorac Surg. 2000; 17: 400-406
        • Toumpoulis I.K.
        • Anagnostopoulos C.E.
        • Swistel D.G.
        • DeRose J.J.
        Does EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery?.
        Eur J Cardiothorac Surg. 2005; 27: 128-133
        • Ly H.Q.
        • Nosair M.
        • Cartier R.
        Surgical turndown: “what’s in a name?” for patients deemed ineligible for surgical revascularization.
        Can J Cardiol. 2019; 35: 959-966
        • Afilalo J.
        • Mottillo S.
        • Eisenberg M.J.
        • et al.
        Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity.
        Circ Cardiovasc Qual Outcomes. 2012; 5: 222-228
        • Yanagawa B.
        • Graham M.
        • Afilalo J.
        • Hassan A.
        • Arora R.
        Frailty as a risk predictor in cardiac surgery: beyond the eyeball test.
        J Thorac Cardiovasc Surg. 2019; 157: 1905-1909
        • Rodríguez-Mañas L.
        • Bayer A.
        • Kelson M.
        • et al.
        Searching for an operational definition of frailty: a Delphi method based consensus statement. The Frailty Operative Definition-Consensus Conference Project.
        J Gerontol A Biol Sci Med Sci. 2012; 68: 62-67
        • Lin H.S.
        • Watts J.N.
        • Peel N.M.
        • Hubbard R.E.
        Frailty and post-operative outcomes in older surgical patients: a systematic review.
        BMC Geriatr. 2016; 16: 157
        • Koh L.Y.
        • Hwang C.N.
        Frailty in cardiac surgery.
        J Cardiothorac Vasc Anesth. 2019; 33: 521-531
        • Dent E.
        • Martin F.C.
        • Bergman H.
        • et al.
        Physical frailty: ICFSR international clinical practice guidelines for identification and management.
        J Nutr Health Aging. 2019; 23: 771-787
        • Sepehri A.
        • Beggs T.
        • Hassan A.
        • et al.
        The impact of frailty on outcomes after cardiac surgery: a systematic review.
        J Thorac Cardiovasc Surg. 2014; 148: 3110-3117
        • Kim D.H.
        • Kim C.A.
        • Placide S.
        • Lipsitz L.A.
        • Marcantonio E.R.
        Preoperative frailty assessment and outcomes at 6 months or later in older adults undergoing cardiac surgical procedures: a systematic review.
        Ann Intern Med. 2016; 165: 650-660
        • Lee D.H.
        • Buth K.J.
        • Martin B.J.
        • Yip A.M.
        • Hirsch G.M.
        Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery.
        Circulation. 2010; 121: 973
        • Li Z.
        • Habbous S.
        • Thain J.
        • et al.
        Cost-effectiveness analysis of frailty assessment in older patients undergoing coronary artery bypass grafting surgery.
        Can J Cardiol. 2020; 36: 490-499
        • Tam D.Y.
        • Qiu F.
        • Elbaz-Greener G.
        • et al.
        Predictors of cumulative health care costs associated with transcatheter aortic valve replacement in severe aortic stenosis.
        Can J Cardiol. 2020; 36: 1244-1251
        • Hosler Q.P.
        • Maltagliati A.J.
        • Shi S.M.
        • et al.
        A practical two-stage frailty assessment for older adults undergoing aortic valve replacement.
        J Am Geriatr Soc. 2019; 67: 2031-2037
        • Cruz-Jentoft A.J.
        • Baeyens J.P.
        • Bauer J.M.
        • et al.
        Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People.
        Age Ageing. 2010; 39: 412-423
        • Savino E.
        • Martini E.
        • Lauretani F.
        • et al.
        Handgrip strength predicts persistent walking recovery after hip fracture surgery.
        Am J Med. 2013; 126: 1068-10675.e1
        • McGrath R.P.
        • Vincent B.M.
        • Lee I.M.
        • Kraemer W.J.
        • Peterson M.D.
        Handgrip strength, function, and mortality in older adults: a time-varying approach.
        Med Sci Sports Exerc. 2018; 50: 2259-2266
        • Leong D.P.
        • Teo K.K.
        • Rangarajan S.
        • et al.
        Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.
        Lancet. 2015; 386: 266-273
        • Celis-Morales C.A.
        • Welsh P.
        • Lyall D.M.
        • et al.
        Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants.
        BMJ. 2018; 361: k1651
        • Revenig L.M.
        • Canter D.J.
        • Kim S.
        • et al.
        Report of a simplified frailty score predictive of short-term postoperative morbidity and mortality.
        J Am Coll Surg. 2015; 220: 904-911.e1
        • Bohannon R.W.
        Muscle strength: clinical and prognostic value of hand-grip dynamometry.
        Curr Opin Clin Nutr Metab Care. 2015; 18: 465-470
        • Pavasini R.
        • Guralnik J.
        • Brown J.C.
        • et al.
        Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis.
        Heart. 2019; 105: 834-841
        • Perry I.S.
        • Pinto L.C.
        • da Silva T.K.
        • Vieira S.R.R.
        • Souza G.C.
        Handgrip strength in preoperative elective cardiac surgery patients and association with body composition and surgical risk.
        Nutr Clin Pract. 2019; 34: 760-766
        • Chauhan D.
        • Haik N.
        • Merlo A.
        • et al.
        Quantitative increase in frailty is associated with diminished survival after transcatheter aortic valve replacement.
        Am Heart J. 2016; 182: 146-154
        • Afilalo J.
        • Lauck S.
        • Kim D.H.
        • et al.
        Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study.
        J Am Coll Cardiol. 2017; 70: 689-700
        • Studenski S.A.
        • Peters K.W.
        • Alley D.E.
        • et al.
        The FNIH Sarcopenia Project: rationale, study description, conference recommendations, and final estimates.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 547-558
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M157
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • et al.
        Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Chainani V.
        • Shaharyar S.
        • Dave K.
        • et al.
        Objective measures of the frailty syndrome (hand grip strength and gait speed) and cardiovascular mortality: a systematic review.
        Int J Cardiol. 2016; 215: 487-493
        • García-Hermoso A.
        • Cavero-Redondoo I.
        • Ramírez-Vélez R.
        • et al.
        Muscular strength as a predictor of all-cause mortality in an apparently healthy population: a systematic review and meta-analysis of data from approximately 2 million men and women.
        Arch Phys Med Rehabil. 2018; 99 (2100-13.e5)
        • Hernández-Luis R.
        • Martín-Ponce E.
        • Monereo-Muñoz M.
        • et al.
        Prognostic value of physical function tests and muscle mass in elderly hospitalized patients. A prospective observational study.
        Geriatr Gerontol Int. 2018; 18: 57-64
        • Hamasaki H.
        • Kawashima Y.
        • Katsuyama H.
        • et al.
        Association of handgrip strength with hospitalization, cardiovascular events, and mortality in Japanese patients with type 2 diabetes.
        Sci Rep. 2017; 7: 7041
        • Jochem C.
        • Leitzmann M.
        • Volaklis K.
        • Aune D.
        • Strasser B.
        Association between muscular strength and mortality in clinical populations: a systematic review and meta-analysis.
        J Am Med Dir Assoc. 2019; 20: 1213-1223
        • Sultan P.
        • Hamilton A.
        • Ackland G.L.
        Preoperative muscle weakness as defined by handgrip strength and postoperative outcomes: a systematic review.
        BMC Anesthesiol. 2012; 12: 1
        • da Silva T.K.
        • Perry I.S.
        • Brauner J.S.
        • et al.
        Performance evaluation of phase angle and handgrip strength in patients undergoing cardiac surgery: Prospective cohort study.
        Aust Crit Care. 2018; 31: 284-290
        • Fu L.
        • Zhang Y.
        • Shao B.
        • et al.
        Perioperative poor grip strength recovery is associated with 30-day complication rate after cardiac surgery discharge in middle-aged and older adults—a prospective observational study.
        BMC Cardiovasc Disord. 2019; 19: 266
        • Reeve T.E.
        • Craven T.E.
        • Goldman M.P.
        • et al.
        Outpatient grip strength measurement predicts survival, perioperative adverse events, and nonhome discharge among patients with vascular disease.
        J Vasc Surg. 2021; 73: 250-257
        • Alley D.E.
        • Shardell M.D.
        • Peters K.W.
        • et al.
        Grip strength cutpoints for the identification of clinically relevant weakness.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 559-566
        • Sawatzky J.A.
        • Kehler D.S.
        • Ready A.E.
        • et al.
        Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study.
        Clin Rehabil. 2014; 28: 648-657
        • Yayla A.
        • Özer N.
        Effects of early mobilization protocol performed after cardiac surgery on patient care outcomes.
        Int J Nurs Pract. 2019; 25e12784
        • Boreskie K.F.
        • Hay J.L.
        • Kehler D.S.
        • et al.
        Prehabilitation: the right medicine for older frail adults anticipating transcatheter aortic valve replacement, coronary artery bypass graft, and other cardiovascular care.
        Clin Geriatr Med. 2019; 35: 571-585
        • Beaudart C.
        • Rolland Y.
        • Cruz-Jentoft A.J.
        • et al.
        Assessment of muscle function and physical performance in daily clinical practice: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).
        Calcif Tissue Int. 2019; 105: 1-14