Prospective assessment of combined handgrip strength and Mini-Cog identifies hospitalized heart failure patients at increased post-hospitalization risk

Abstract

Aims: The utility of combined assessment of both frailty and cognitive impairment in hospitalized heart failure (HF) patients for incremental post-discharge risk stratification, using handgrip strength and Mini-Cog as feasible representative parameters, was investigated.

Methods and results: A prospective, single-centre cohort study of older adults (age ≥65) hospitalized for HF being discharged to home was performed. Pre-discharge, grip strength was assessed using a dynamometer (Jamar hydrolic hand dynamometer, Lafayette Instruments, Lafayette, IN, USA) and was defined as weak if the maximal value was below the gender-derived and body mass index-derived cut-offs according to Fried criteria. Cognition was assessed using the Mini-Cog. The presence of impairment was defined as a score of <2. Outcome measures were all-cause readmission or emergency department visit (primary) or all-cause mortality (secondary) at 6 months. A total of 56 patients (mean age 77 ± 7 years, 73% male) were enrolled. The majority (n = 33, 59%) had weak grip strength, either with (n = 5) or without (n = 28) cognitive impairment. The highest risk for both readmission and mortality occurred in those with weak grip strength and cognitive impairment in combination (log-rank P < 0.0001 and P = 0.01, respectively).

Conclusions: Patients who are frail by grip strength assessment and cognitively impaired according to severely reduced Mini-Cog performance show the worst midterm post-discharge outcomes after HF hospitalization.

Keywords: Cognitive impairment; Frailty; Grip strength; Hospitalized heart failure; Readmission.

Figure 1

Freedom from readmission or emergency department visit at 6 months.

Figure 2

Freedom from all‐cause mortality at 6 months.