Date Presented 04/04/2025
Frailty and weak grip strength (GS) are commonly observed among persons with heart failure. Research is limited on the impact of preoperative GS on functional outcomes for left ventricular assist device (LVAD) recipients. This study aims to determine whether preoperative GS predicts postoperative outcomes.
Primary Author and Speaker: Sydney Georgiou
Additional Authors and Speakers: Jessica D. Asiello, John Wong, Christina Kelley, Abigail Begin, Marissa Dittrich, Erin Donovan, Nicole C. Lam, Alyssa M. Taubert, Dana Kuhn, Nicole Lyons
PURPOSE: Left Ventricular Assist Devices (LVADs) are life saving devices for advanced heart failure (HF). Frailty and weak grip strength (GS) are commonly observed in HF, but there is limited research on their link to functional outcomes.The objective of this study was to evaluate if pre-operative GS is predictive of post-operative outcomes for patients who receive LVADs.
DESIGN: This retrospective study included 33 patients with end-stage HF who participated in pre-implantation OT evaluation, received an LVAD, and completed a 90-180 day postoperative survey.
METHOD: Data was collected via medical record review and telephone follow-up survey. The preop variables was GS from OT evaluation. Postop variables were length of stay and self-report AM-PAC, LVAD independence, and Satisfaction with Life Scale scores. Through a Pearson correlation test, data for pre-op GS were compared to data for post-op outcomes. Additional analyses were conducted using a linear regression model.
RESULTS: No statistically significant correlation was found between pre-op GS and the measured post-op outcomes. Additional analyses revealed a strong correlation between age and pre-op GS. Age showed strong correlations with LVAD self-management scores from the 90–180-day follow-up survey. Grip strength and age were predictors of OTs observed level of assistance needed to manage LVAD battery prior to discharge.
CONCLUSIONS: The study revealed pre-op GS is not a strong predictor of 3-6 month functional postop outcomes of post-acute occupational performance, satisfaction with life, independence in device management, or length of stay. GS predicted immediate postop LVAD battery management. LVAD candidacy should be considered through a holistic OT approach as GS on its own is not enough to predict likely outcomes. Further studies are needed to explore the relationships between client factors and post-operative outcomes in order to establish guidelines and inform quality of care.
References
Chung, C. J., Wu, C., Jones, M., Kato, T. S., Dam, T. T., Givens, R. C., Templeton, D. L., Maurer, M. S., Naka, Y., Takayama, H., Mancini, D. M., & Schulze, P. C. (2014). Reduced handgrip strength as a marker of frailty predicts clinical outcomes in patients with heart failure undergoing ventricular assist device placement. Journal of Cardiac Failure, 20(5), 310–315. https://doi.org/10.1016/j.cardfail.2014.02.008
Flint, K. M., & Allen, L. A. (2014). Getting a grip on frailty: Handgrip strength in patient selection for left ventricular assist device. Journal of Cardiac Failure, 20(5), 316–318. https://doi.org/10.1016/j.cardfail.2014.03.002
Yuzefpolskaya, M., Schroeder, S. E., Houston, B. A., Robinson, M. R., Gosev, I., Reyentovich, A., Koehl, D., Cantor, R., Jorde, U. P., Kirklin, J. K., Pagani, F. D., & D’Alessandro, D. A. (2023). The Society of Thoracic Surgeons Intermacs 2022 Annual Report: Focus on the 2018 Heart Transplant Allocation System. The Annals of Thoracic Surgery, 115(2), 311–327. https://doi.org/10.1016/j.athoracsur.2022.11.023
