8 Reversibility of frailty in LVAD and heart transplant patients

Abstract

Frailty is a condition that is characterised by reduced physiological reserve. Multiple instruments have been developed to measure frailty mainly in community-dwelling elderly people.1 We have adapted one of these instruments, the Fried frailty phenotype, to assess frailty in patients with advanced heart failure (AHF) referred for consideration of ventricular assist device (VAD) implantation and/or heart transplantation (HTx). Since 2013, when possible all AHF patients referred to our centre have been assessed for frailty. Fried’s five physical domains – exhaustion, grip-strength, mobility, appetite and physical inactivity (frail ≥3/5), as well as cognitive impairment (MoCA ≤26) and depression (DMI >9) were assessed. We have demonstrated that frailty is associated with increased mortality in patients with AHF2 3 and increased morbidity and mortality after VAD implantation and after heart transplantation.4 Despite the increased morbidity and mortality post-intervention, physical frailty is reversible in the majority of patients undergoing bridge-to-transplant VAD implantation and HTx. Of the individual frailty domains, change in handgrip strength is the least sensitive indicator of improved frailty status. Future goals or challenges in frailty research in the setting of AHF include the development of a universally accepted frailty measurement, the development of measures that distinguish reversible from irreversible frailty, and the role of pre-habilitation in reducing frailty-associated morbidity and mortality after VAD or HTx. References McDonagh J, Martin L, Ferguson C, et al. Frailty assessment instruments in heart failure: A systematic review. Eur J Cardiovasc Nursing 2017 May 1:1474515117708888. Jha S, Carter D, Hannu MK, et al. Frailty as a predictor of outcomes in transplant eligible patients with advanced heart failure. Transplantation 2016;100:429–436. Jha S, Carter D, Hannu MK, et al. Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. J Heart Lung Transplant 2016;35:1092–1100. Jha S, Hannu MK, Newton P, et al. Reversibility of frailty after bridge-to-transplant ventricular assist device implantation or heart transplantation. Transplantation Direct 2017;3:e167.