Prognostic Value of Handgrip Strength in Older Adults Undergoing Cardiac Surgery

Can J Cardiol. 2021 Nov;37(11):1760-1766. doi: 10.1016/j.cjca.2021.08.016. Epub 2021 Aug 28.


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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 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