Hand Grip Strength as a Predictor of Mortality and Quality of Life in Heart Failure Patients

Hand Grip Strength as a Predictor of Mortality and Quality of Life in Heart Failure Patients


Hand grip strength (HGS) has emerged as a significant predictor of mortality and quality of life in patients with heart failure (HF). This simple, non-invasive measure of muscular strength is increasingly recognized for its prognostic value in cardiovascular health. This article reviews clinical evidence supporting the use of hand grip strength as a predictor in heart failure patients, highlighting its potential in routine clinical assessments.

Hand Grip Strength: An Overview

Hand grip strength is measured using a dynamometer, a device that measures the amount of force the hand can squeeze in either kilograms or pounds, providing an objective measure of upper body strength. It is influenced by factors such as age, sex, nutritional status, and overall health. In the context of heart failure, reduced hand grip strength reflects not just muscular weakness but also the systemic impact of heart disease on physical conditioning and health status (Leong et al., 2015).

Hand Grip Strength and Mortality in Heart Failure

Various reports have demonstrated a correlation between reduced hand grip strength and increased mortality in HF patients. A landmark study found that lower hand grip strength was independently linked with a higher risk of cardiovascular mortality in older adults. This association was considerable in patients with existing cardiovascular conditions, including HF (Jefferis et al., 2014).

In a more specific context, a study by Izawa et al. (2017) focused on heart patients and found that those with lower grip strength had significantly higher mortality rates. This study suggested that grip strength could be a simple and effective tool for risk stratification in heart failure patients.

Hand Grip Strength as a Marker of Frailty

Frailty is a common condition in HF patients, characterized by decreased physiological reserve and increased vulnerability to stressors. Grip strength has emerged as a single-item marker of frailty. Their study on a cohort of patients with advanced HF in Singapore found that a decline in grip strength was associated with increased all-cause mortality and worse quality of life across physical, functional, emotional, and social domains (Dai et al.,2022).

Association with Mortality

The same study also revealed that patients with weak grip strength had significantly decreased survival rates compared to those with normal grip strength. Specifically, a decrease of 1 unit in grip strength was associated with a 12% increase in the mortality rate. This finding underscores the importance of grip strength as a prognostic tool in clinical practice for HF patients. Various prospective studies have described the association between hand grip strength and health decline in the elderly, predominantly describing its association with functional disability and mortality (Taekema et al., 2010).

Hand Grip Strength and Quality of Life

The quality of life is a critical consideration in heart failure management, and hand grip strength has been linked to various quality-of-life measures within this population. A study by Sayer et al. (2006) showed that lower grip strength was associated with poorer physical function and quality of life in older adults. This relationship is particularly relevant in heart failure, where physical functioning can be significantly compromised.

Furthermore, a study by Fess et al. (2012) highlighted the role of hand grip strength in predicting the ability to perform daily activities, a key component of quality of life. In HF patients, reduced hand grip strength was associated with difficulties in activities of daily living, signifying its importance in patient care.

Mechanisms Linking Hand Grip Strength to Heart Failure Outcomes

A study by Umehara et al. (2023) focuses on muscle strength and skeletal muscle mass in elderly patients with heart failure. It specifically examines hand-grip strength and the results of the five times sit-to-stand (5STS) test. The key finding is that while these patients showed significant declines in both hand-grip strength and 5STS performance, their skeletal muscle mass did not decrease. This suggests that heart failure in the elderly is associated with a reduction in muscle strength independent of muscle mass, underscoring the importance of assessing and addressing muscle function in this patient group.

Additionally, hand grip strength reflects overall nutritional status, which is crucial in heart failure management. Malnutrition is common in heart failure patients and can lead to muscle wasting and reduced grip strength, further exacerbating heart failure symptoms (Fernández et al., 2021).

Clinical Implications and Future Directions

The evidence suggests that hand grip strength measurement should be incorporated into routine clinical assessments of heart failure patients. It offers a quick, cost-effective method for risk stratification and potentially functional status in this population. Future research should focus on longitudinal studies to better understand the causal relationships and potential interventions to improve heart failure patients' hand grip strength and outcomes.


Grip strength is a valuable predictor of mortality and quality of life in heart failure patients. Its ease of measurement and strong prognostic value make it an essential tool in managing heart failure. As research continues to evolve, hand grip strength will likely become integral to heart failure patient assessments, aiding in personalized care and management strategies.

Given the established link between hand grip strength and mortality and quality of life in heart failure patients, emerging technologies like the Squegg Smart Dynamometer offer promising avenues for further research. The Squegg, a Bluetooth-enabled grip strengthener, measures grip strength and allows patients to engage in regular, quantifiable strength training. Its integration with a mobile application for tracking progress adds a layer of convenience and precision in monitoring grip strength.


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  8. Umehara, T., Kaneguchi, A., Yamasaki, T., Katayama, N., Kawakami, W., Kuwahara, D., & Kito, N. (2023). Reduced upper and lower limb muscle strengths without reduced skeletal muscle in elderly patients with heart failure. Journal of Rural Medicine: JRM, 18(1), 8–14. https://doi.org/10.2185/jrm.2022-029.

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