Does skeletal muscle weakness recognized early during hospitalization for acute heart failure predict short-term mortality?

Impairment of skeletal muscle is common in heart failure (HF) but understudied in acute episodes. To assess the relationship between skeletal muscle weakness identified early during hospitalization for acute HF and the risk of hospital mortality. we conducted a prospective, single center study enrolling patients ≥ 18 years old admitted from the emergency department with acute HF (March 2023–April 2024). We excluded individuals with other causes of muscle weakness, including dementia, delirium and cerebrovascular disease. In the ward, a physical educator performed handgrip tests and values < 27 (men) and 16 kg (women) were used to define muscle weakness (according to EWGSOP2). In the same day, all participants underwent clinical examination by a cardiologist who assessed signs of congestion and hypoperfusion to classify patients into the 4 clinical-hemodynamic profiles established in the literature (A, B, C and L). The sample consisted of 37 participants, who were 68 (±15) years old (mean ± standard deviation) and predominantly men (68%). We performed the study procedures in 2 (2) days (median and interquartile range) after patients arrived at the emergency department. The handgrip tests identified 15 participants with skeletal muscle weakness (40% of the sample). This group had more severe clinical presentations of HF, with a higher proportion of participants showing both congestion and hypoperfusion signs (profile C) than the group with normal strength (47 vs 5%; P = 0.020). The in-hospital mortality rate was 33% in the group with muscle weakness compared to 5% in the group with normal strength ( P = 0.031). A logistic regression model (Chi-square = 5.568; df =1; P = 0,018; R 2 = 0.238) showed muscle weakness as the only variable independently associated with hospital mortality ( P = 0.043). Early recognition of muscle weakness identified a group of patients with acute HF at increased risk of hospital mortality.