Prognostic Value of Handgrip Strength in Older Adults Undergoing Cardiac Surgery

• Published in: Canadian journal of cardiology 2021-11, Vol.37 (11), p.1760-1766
• Main Authors: Fountotos, Rosie, Munir, Haroon, Goldfarb, Michael, Lauck, Sandra, Kim, Dae, Perrault, Louis, Arora, Rakesh, Moss, Emmanuel, Rudski, Lawrence G., Bendayan, Melissa, Piankova, Palina, Hayman, Victoria, Rodighiero, Julia, Ouimet, Marie-Claude, Lantagne, Sarah, Piazza, Nicolo, Afilalo, Jonathan
• Format: Article
• Language: English
• Subjects: Aged; Canada - epidemiology; Cardiac Surgical Procedures; Female; Follow-Up Studies; Frailty - complications; Frailty - epidemiology; Frailty - physiopathology; Hand Strength - physiology; Heart Diseases - complications; Heart Diseases - surgery; Humans; Male; Middle Aged; Morbidity - trends; Postoperative Period; Prognosis; Prospective Studies; Risk Assessment - methods; Survival Rate - trends; United States - epidemiology
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2021.08.016

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