Abstract 17795: Prospective Assessment of Mini-Cog and Grip Strength Identifies Hospitalized Heart Failure Patients at Increased Risk of Worse Post-Discharge Outcomes
Introduction: The prevalence and clinical impact of frailty and cognitive impairment (CI) are being increasingly recognized in hospitalized heart failure (HF) patients. The aim of this study was to determine the combined utility of cognitive function and handgrip strength assessment (HGS) for post-hospitalization risk stratification.
Methods: This was a single-center prospective cohort study of older adults (age 65 years or above) hospitalized for HF being discharged to home. Prior to discharge, HGS was assessed using a dynamometer (Jamar, Inc.) and weak HGS was defined as a maximal value below the gender- and body mass index-derived cut-offs according to the Fried criteria. Cognition was assessed using the Mini-Cog and presence of CI was defined as a score of <2. Primary outcome measure was the first occurrence of either all-cause readmission or emergency department visit up to 6-months. Secondary outcome measure was 6-month all-cause mortality.
Results: A total of 56 patients (mean age 77±7years, 73% male, 32% preserved ejection fraction, 36% coronary artery disease) consented to participate. The majority of the cohort (n=33, 59%) had weak HGS and/or CI (weak/CI absent, n=28; weak/CI present, n=5; strong/CI present, n=0). Patients who had both weak HGS and CI were more likely to have active or prior cancer (p=0.03) and have a physical disability (p=0.03). On Kaplan-Meier analysis, highest risk for the primary outcome occurred in those with weak HGS and CI (log-rank p<0.0001) (Fig. 1). Similar curves were seen for all-cause mortality analysis (log-rank p=0.01).
Conclusions: Patients who are frail by grip strength assessment and cognitively impaired as identified by severely reduced Mini-Cog performance show the worst mid-term post-discharge outcomes after HF hospitalization. Prospective assessment of both of these highly feasible clinical biomarkers in combination may provide incremental post-hospitalization risk stratification.
Author Disclosures: E. Joyce: None. E.H. Howell: None. A. Senapati: None. R.C. Starling: None. E.Z. Gorodeski: Consultant/Advisory Board; Modest; Novartis.
- © 2016 by American Heart Association, Inc.