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Grip strength measurement for frailty assessment in patients with vascular disease and associations with comorbidity, cardiac risk, and sarcopenia.
J Vasc Surg. 2018 05; 67(5):1512-1520.JV

Abstract

OBJECTIVE

Frailty is associated with adverse events, length of stay, and nonhome discharge after vascular surgery. Frailty measures based on walking-based tests may be impractical or invalid for patients with walking impairment from symptoms or sequelae of vascular disease. We hypothesized that grip strength is associated with frailty, comorbidity, and cardiac risk among patients with vascular disease.

METHODS

Dominant hand grip strength was measured during ambulatory clinic visits among patients with vascular disease (abdominal aortic aneurysm [AAA], carotid stenosis, and peripheral artery disease [PAD]). Frailty prevalence was defined on the basis of the 20th percentile of community-dwelling population estimates adjusted for age, gender, and body mass index. Associations between grip strength, Charlson Comorbidity Index (CCI), Revised Cardiac Risk Index (RCRI), and sarcopenia (based on total psoas area for patients with cross-sectional abdominal imaging) were evaluated using linear and logistic regression.

RESULTS

Grip strength was measured in 311 participants; all had sufficient data for CCI calculation, 217 (69.8%) had sufficient data for RCRI, and 88 (28.3%) had cross-sectional imaging permitting psoas measurement. Eighty-six participants (27.7%) were categorized as frail on the basis of grip strength. Frailty was associated with CCI (odds ratio, 1.86; 95% confidence interval, 1.34-2.57; P = .0002) in the multivariable model. Frail participants also had a higher average number of RCRI components vs nonfrail patients (mean ± standard deviation, 1.8 ± 0.8 for frail vs 1.5 ± 0.7 for nonfrail; P = .018); frailty was also associated with RCRI in the adjusted multivariable model (odds ratio, 1.75; 95% confidence interval, 1.16-2.64; P = .008). Total psoas area was lower among patients categorized as frail vs nonfrail on the basis of grip strength (21.0 ± 6.6 vs 25.4 ± 7.4; P = .010). Each 10 cm2 increase in psoas area was associated with a 5.7 kg increase in grip strength in a multivariable model adjusting for age and gender (P < .0001). Adjusted least squares mean psoas diameter estimates were 25.5 ± 1.1 cm2 for participants with AAA, 26.7 ± 2.0 cm2 for participants with carotid stenosis, and 22.7 ± 0.8 cm2 for participants with PAD (P = .053 for PAD vs AAA; P = .057 for PAD vs carotid stenosis; and P = .564 for AAA vs carotid stenosis).

CONCLUSIONS

Grip strength is useful for identifying frailty among patients with vascular disease. Frail status based on grip strength is associated with comorbidity, cardiac risk, and sarcopenia in this population. These findings suggest that grip strength may have utility as a simple and inexpensive risk screening tool that is easily implemented in ambulatory clinics, avoids the need for imaging, and overcomes possible limitations of walking-based measures. Lower mean psoas diameters among patients with PAD vs other diagnoses may warrant consideration of specific approaches to morphomic analysis.

Authors+Show Affiliations

Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC.Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC.Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC.Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich. Electronic address: mcorrier@med.umich.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29276105

Citation

Reeve, Thomas E., et al. "Grip Strength Measurement for Frailty Assessment in Patients With Vascular Disease and Associations With Comorbidity, Cardiac Risk, and Sarcopenia." Journal of Vascular Surgery, vol. 67, no. 5, 2018, pp. 1512-1520.
Reeve TE, Ur R, Craven TE, et al. Grip strength measurement for frailty assessment in patients with vascular disease and associations with comorbidity, cardiac risk, and sarcopenia. J Vasc Surg. 2018;67(5):1512-1520.
Reeve, T. E., Ur, R., Craven, T. E., Kaan, J. H., Goldman, M. P., Edwards, M. S., Hurie, J. B., Velazquez-Ramirez, G., & Corriere, M. A. (2018). Grip strength measurement for frailty assessment in patients with vascular disease and associations with comorbidity, cardiac risk, and sarcopenia. Journal of Vascular Surgery, 67(5), 1512-1520. https://doi.org/10.1016/j.jvs.2017.08.078
Reeve TE, et al. Grip Strength Measurement for Frailty Assessment in Patients With Vascular Disease and Associations With Comorbidity, Cardiac Risk, and Sarcopenia. J Vasc Surg. 2018;67(5):1512-1520. PubMed PMID: 29276105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Grip strength measurement for frailty assessment in patients with vascular disease and associations with comorbidity, cardiac risk, and sarcopenia. AU - Reeve,Thomas E,4th AU - Ur,Rebecca, AU - Craven,Timothy E, AU - Kaan,James H, AU - Goldman,Matthew P, AU - Edwards,Matthew S, AU - Hurie,Justin B, AU - Velazquez-Ramirez,Gabriela, AU - Corriere,Matthew A, Y1 - 2017/12/21/ PY - 2017/05/09/received PY - 2017/08/16/accepted PY - 2017/12/26/pubmed PY - 2018/6/27/medline PY - 2017/12/26/entrez SP - 1512 EP - 1520 JF - Journal of vascular surgery JO - J Vasc Surg VL - 67 IS - 5 N2 - OBJECTIVE: Frailty is associated with adverse events, length of stay, and nonhome discharge after vascular surgery. Frailty measures based on walking-based tests may be impractical or invalid for patients with walking impairment from symptoms or sequelae of vascular disease. We hypothesized that grip strength is associated with frailty, comorbidity, and cardiac risk among patients with vascular disease. METHODS: Dominant hand grip strength was measured during ambulatory clinic visits among patients with vascular disease (abdominal aortic aneurysm [AAA], carotid stenosis, and peripheral artery disease [PAD]). Frailty prevalence was defined on the basis of the 20th percentile of community-dwelling population estimates adjusted for age, gender, and body mass index. Associations between grip strength, Charlson Comorbidity Index (CCI), Revised Cardiac Risk Index (RCRI), and sarcopenia (based on total psoas area for patients with cross-sectional abdominal imaging) were evaluated using linear and logistic regression. RESULTS: Grip strength was measured in 311 participants; all had sufficient data for CCI calculation, 217 (69.8%) had sufficient data for RCRI, and 88 (28.3%) had cross-sectional imaging permitting psoas measurement. Eighty-six participants (27.7%) were categorized as frail on the basis of grip strength. Frailty was associated with CCI (odds ratio, 1.86; 95% confidence interval, 1.34-2.57; P = .0002) in the multivariable model. Frail participants also had a higher average number of RCRI components vs nonfrail patients (mean ± standard deviation, 1.8 ± 0.8 for frail vs 1.5 ± 0.7 for nonfrail; P = .018); frailty was also associated with RCRI in the adjusted multivariable model (odds ratio, 1.75; 95% confidence interval, 1.16-2.64; P = .008). Total psoas area was lower among patients categorized as frail vs nonfrail on the basis of grip strength (21.0 ± 6.6 vs 25.4 ± 7.4; P = .010). Each 10 cm2 increase in psoas area was associated with a 5.7 kg increase in grip strength in a multivariable model adjusting for age and gender (P < .0001). Adjusted least squares mean psoas diameter estimates were 25.5 ± 1.1 cm2 for participants with AAA, 26.7 ± 2.0 cm2 for participants with carotid stenosis, and 22.7 ± 0.8 cm2 for participants with PAD (P = .053 for PAD vs AAA; P = .057 for PAD vs carotid stenosis; and P = .564 for AAA vs carotid stenosis). CONCLUSIONS: Grip strength is useful for identifying frailty among patients with vascular disease. Frail status based on grip strength is associated with comorbidity, cardiac risk, and sarcopenia in this population. These findings suggest that grip strength may have utility as a simple and inexpensive risk screening tool that is easily implemented in ambulatory clinics, avoids the need for imaging, and overcomes possible limitations of walking-based measures. Lower mean psoas diameters among patients with PAD vs other diagnoses may warrant consideration of specific approaches to morphomic analysis. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/29276105/Grip_strength_measurement_for_frailty_assessment_in_patients_with_vascular_disease_and_associations_with_comorbidity_cardiac_risk_and_sarcopenia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(17)32211-5 DB - PRIME DP - Unbound Medicine ER -