• Emer Joyce, Erik H Howell, Alpana Senapati, Randall C Starling, and Eiran Z Gorodeski.
• Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Desk J3-4, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
• ESC Heart Fail. 2018 Oct 1; 5 (5): 948-952.

AimsThe utility of combined assessment of both frailty and cognitive impairment in hospitalized heart failure (HF) patients for incremental post-discharge risk stratification, using handgrip strength and Mini-Cog as feasible representative parameters, was investigated.Methods And ResultsA prospective, single-centre cohort study of older adults (age ≥65) hospitalized for HF being discharged to home was performed. Pre-discharge, grip strength was assessed using a dynamometer (Jamar hydrolic hand dynamometer, Lafayette Instruments, Lafayette, IN, USA) and was defined as weak if the maximal value was below the gender-derived and body mass index-derived cut-offs according to Fried criteria. Cognition was assessed using the Mini-Cog. The presence of impairment was defined as a score of <2. Outcome measures were all-cause readmission or emergency department visit (primary) or all-cause mortality (secondary) at 6 months. A total of 56 patients (mean age 77 ± 7 years, 73% male) were enrolled. The majority (n = 33, 59%) had weak grip strength, either with (n = 5) or without (n = 28) cognitive impairment. The highest risk for both readmission and mortality occurred in those with weak grip strength and cognitive impairment in combination (log-rank P < 0.0001 and P = 0.01, respectively).ConclusionsPatients who are frail by grip strength assessment and cognitively impaired according to severely reduced Mini-Cog performance show the worst midterm post-discharge outcomes after HF hospitalization.© 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

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