Stress hyperglycemia ratio and physical frailty in HFpEF

Stress hyperglycemia, reflected by the stress hyperglycemia ratio (SHR), is increasingly recognized as a marker of adverse cardiovascular outcomes in both diabetic and non-diabetic patients. Stress-induced hyperglycemia arises from acute metabolic and inflammatory stress responses and may signify impaired glycemic resilience. Heart failure with preserved ejection fraction (HFpEF) commonly coexists with metabolic abnormalities such as hyperglycemia, prediabetes, and diabetes, while physical frailty-frequent in older adults-is mechanistically linked to both dysglycemia and HFpEF. In this study, we aimed to investigate the association between SHR and physical performance in frail older adults with HFpEF.

We conducted a prospective observational study enrolling consecutive frail adults aged > 65 years with a confirmed diagnosis of HFpEF and Montreal cognitive assessment (MoCA) score < 26. Frailty was defined by ≥ 3 of 5 Fried criteria (low physical activity, unintentional weight loss, exhaustion, weakness, and slowness). SHR was calculated as the ratio of admission plasma glucose (mmol/L) to estimated chronic glucose derived from HbA1c (%). Participants were stratified into two groups: SHR ≤ 1 and SHR > 1. Physical function was assessed by gait speed (m/s).

Of 295 screened individuals, 204 met inclusion criteria and completed the study. Patients with SHR > 1 demonstrated significantly reduced physical performance compared with those with SHR ≤ 1 (mean gait speed 0.65 ± 0.20 m/s vs. 0.72 ± 0.20 m/s, p = 0.0004).

A higher SHR was independently associated with poorer physical function in frail older adults with HFpEF. These findings suggest that stress-related dysglycemia may contribute to functional decline in this population, highlighting the potential utility of SHR as a metabolic marker of frailty severity and cardiovascular vulnerability.