Abstract 4367017: Handgrip Strength, Obesity, and Outcomes in Heart Failure with Preserved Ejection Fraction

Background: Obesity is paradoxically associated with better outcomes in adults with heart failure with preserved ejection fraction (HFpEF). Handgrip strength is a simple validated measure of systemic muscle strength and serves as a proxy for sarcopenia and frailty—conditions that are clinically relevant in HFpEF. The prognostic value of handgrip strength, particularly in relation to body habitus, is unknown in this population. Goals/Aims This study aimed to examine the relationship between low handgrip strength, body habitus, and clinical outcomes in adults with HFpEF. Methods: We examined 255 ambulatory patients with HFpEF seen at Weill Cornell Medicine from June 2018 – November 2023. Handgrip strength was measured with a dynomanomter using the average handgrip strength from both hands. Low handgrip strength was defined as values < 29.0 kg for men and < 18.0 kg for women. Cox proportional-hazard model analysis was used to examine the association between low handgrip strength and the composite endpoint (a 1-year composite of all-cause mortality and all-cause hospitalization) adjusting for race, the MAGGIC prognostic risk score and malnutrition: this was conducted among the entire cohort, and also among those with and without obesity (based on BMI ≥ 30 and < 30). Results: The median age was 77.0 years (IQR [69.0-84.0]), LVEF was 63.0 (IQR [59.0-67.0]), BMI was 29.9 (IQR [25.90 – 36.59]) and MAGGIC risk score was 24.0 (IQR [19.0-28.0]). The prevalence of low handgrip strength was 66.3% overall (n=169), 43.2% in obese (n=73) and 56.8% in non-obese (n=96) patients. Figure 1 shows results of the cox poportional hazard models. Among the entire cohort, low handgrip strength was associated with the composite endpoint in a crude model, but not after adjusting for covariates. Among the obesity strata, low handgrip strength was associated with the composite endpoint in non-obese patients with HFpEF, but not in obese patients with HFpEF. Conclusion: Low handgrip strength is associated with adverse outcomes in non-obese patients with HFpEF. This data supports the value of handgrip strength as an incrementally valuable prognostic tool in patients with HFpEF.