Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Rd, Singapore, 169857.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
ESC Heart Fail. 2024 Feb;11(1):306-314. doi: 10.1002/ehf2.14573. Epub 2023 Nov 21.
Frailty increases healthcare utilization and costs for patients with heart failure but is challenging to assess in clinical settings. Hand grip strength (GS) is a single-item measure of frailty yet lacks evidence as a potential screening tool to identify patients at risk of higher unplanned events and related healthcare costs. We examined the association of baseline and longitudinal GS measurements with healthcare utilization and costs among patients with advanced heart failure.
Between July 2017 and April 2019, we enrolled 251 patients with symptoms of advanced heart failure (New York Heart Association class III or IV) in a prospective cohort study in Singapore. We measured GS at baseline and every 4 months for 2 years and linked patients' survey data with their medical and billing records. We categorized patients as having weak GS if their GS measurement was below the 5th percentile of the age- and gender-specific normative GS values in Singapore. We assessed the association between baseline GS and healthcare utilization (unplanned and planned events and healthcare costs, total costs, and length of inpatient stay) over the next 2 years using regression models. We investigated the association between longitudinal 4-monthly GS assessments and the ensuing 4 months of healthcare utilization and costs using mixed-effects logistic and two-part regression models. At baseline, 22.5% of patients had weak GS. Baseline and longitudinal GS measurements were significantly associated with longer length of inpatient stay, greater likelihood of unplanned events, and higher related costs. Patients with weak GS had higher odds of an unplanned event occurring by 8 percentage points [95% confidence interval (CI) (0.01, 0.14), P = 0.026], incurred longer inpatient stays by 4 days [95% CI (1.97, 6.79), P = 0.003], and additional SG$ 4792 [US$ ~ 3594, 95% CI (1894, 7689), P = 0.014] in unplanned healthcare costs over the next 4 months.
GS is a simple tool to identify and monitor heart failure patients at risk of unplanned events, longer inpatient stays, and higher related healthcare costs. Findings support its routine use in clinical settings.
衰弱会增加心力衰竭患者的医疗保健利用和成本，但在临床环境中评估衰弱具有挑战性。握力（GS）是一种衡量衰弱的单项指标，但缺乏作为潜在筛查工具的证据，无法识别有更高非计划性事件和相关医疗保健费用风险的患者。我们研究了基线和纵向 GS 测量值与晚期心力衰竭患者的医疗保健利用和成本之间的关系。
2017 年 7 月至 2019 年 4 月，我们在新加坡的一项前瞻性队列研究中招募了 251 名有晚期心力衰竭症状的患者（纽约心脏协会 [NYHA] 心功能 III 或 IV 级）。我们在基线和每 4 个月测量一次 GS，为期 2 年，并将患者的调查数据与他们的医疗和计费记录相关联。如果 GS 测量值低于新加坡年龄和性别特定的 GS 值的第 5 百分位数，则将患者归类为握力较弱。我们使用回归模型评估基线 GS 与未来 2 年内的医疗保健利用（非计划性和计划性事件以及医疗保健费用、总费用和住院时间）之间的关系。我们使用混合效应逻辑和两部分回归模型研究了每 4 个月的纵向 GS 评估与随后的 4 个月医疗保健利用和成本之间的关系。基线时，22.5%的患者握力较弱。基线和纵向 GS 测量值与较长的住院时间、更高的非计划性事件发生率和更高的相关成本显著相关。握力较弱的患者发生非计划性事件的可能性高 8 个百分点 [95%置信区间（CI）（0.01，0.14），P=0.026]，住院时间延长 4 天 [95%CI（1.97，6.79），P=0.003]，并且在接下来的 4 个月内非计划性医疗保健费用增加 SG$4792 [US$~3594，95%CI（1894，7689），P=0.014]。
GS 是一种简单的工具，可以识别和监测有非计划性事件、住院时间延长和更高相关医疗保健费用风险的心力衰竭患者。研究结果支持其在临床环境中的常规使用。
