Prognostic Value of Handgrip Strength in Older Patients With Heart Failure: A Post Hoc Analysis of FRAGILE-HF.

BACKGROUND

The prognostic value of handgrip strength, a simple and reliable indicator of sarcopenia, in older patients with heart failure remains uncertain. This study aimed to investigate the prognostic value of handgrip strength in hospitalized patients aged ≥65 years with heart failure.

METHODS

This post hoc analysis used data from FRAGILE-HF (Prevalence and Prognostic Value of Physical and Social Frailty in Geriatric Patients Hospitalized for Heart Failure), a prospective, multicenter cohort study involving patients aged ≥65 years hospitalized for heart failure. Handgrip strength was measured before discharge using a dynamometer, with the higher value from 2 trials recorded. Measurements were standardized by dividing 28 and 18 kg for men and women, respectively, per 2019 Asian Working Group for Sarcopenia criteria. Patients were categorized into tertiles (tertile 1, highest; tertile 2, middle; and tertile 3, lowest). The primary outcome was 2-year all-cause death.

RESULTS

Among 1269 patients (median age, 81 years; 57.1% men), 275 died during follow-up. Kaplan-Meier analysis revealed a stepwise increase in death across the lowest handgrip tertiles, which remained significant after multivariable adjustment (tertile 2 versus tertile 1: hazard ratio [HR], 1.64 [95% CI, 1.14-2.37]; P=0.007; tertile 3 versus tertile 1: HR, 2.03 [95% CI, 1.42-2.90]; P<0.001). The analysis using a linear model showed that the prognostic impact of reduced handgrip strength increased with age.

CONCLUSIONS

Lower handgrip strength was independently associated with death in older patients with heart failure, with stronger associations observed in the oldest patients. These findings highlight the additional prognostic value of handgrip strength beyond conventional risk factors.

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