Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy

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Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population.

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Methods

This was a prospective observational study of hospitalized patients with advanced HF who were scheduled for LVAD implantation. Participants were enrolled between February 2013 and May 2014 and within 2 weeks before the scheduled date of implantation. All patients able to answer the study questions were eligible for enrollment, irrespective of age or implant strategy, that is, bridge-to-transplant (BTT) or destination therapy (DT). Patients who were intubated or sedated were not included, as

Results

A total of 75 patients met the eligibility criteria and were included in the analysis. An additional 2 patients were consented but did not receive an LVAD. Patient demographics are presented in Table 2. As many as 29% (n = 22) received the LVAD as DT, whereas the remaining majority were patients treated with BTT LVAD. The median time (first quartile, third quartile) between frailty assessment and LVAD implantation was 1.0 days (2.0, 4.0). In this cohort, 44 patients (59%) met the adapted Fried

Discussion

In this single-center study with a relatively large sample size, we found that nearly 60% of patients with advanced HF were frail according to the Fried criteria. Furthermore, an abridged version of the Fried criteria was associated with the combined end point of in-hospital mortality and prolonged length of stay, and was also associated with prolonged time on the ventilator and time to hospital discharge. These effects remained robust after adjusting for age, gender, and MELD score. To our

Acknowledgment

This study received no funding. Dr. Joseph received speaker honoraria from St. Jude Medical. Dr. Silvestry is a consultant for St. Jude Medical and HeartWare. There are no other disclosures.

Disclosures

The authors have no conflicts of interest to disclose.

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