Frailty Assessment in Advanced Heart Failure

Madan, Shivank; Fida, Nadia; Barman, Poulami; Sims, Daniel B.; Shin, J.; Verghese, Joe; Piña, Ileana L.; Jorde, Ulrich P.; Patel, Snehal R.

doi:10.1016/j.cardfail.2016.02.003

Cited by 51 publications

(49 citation statements)

References 14 publications

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“…We hypothesized that factors such as age, comorbidities, laboratory parameters, and INTERMACS score at baseline could be used to identify the subgroup of frail older adults with HF who receive a LVAD and remain frail, but age, sex, INTERMACS score, and nutritional state, as evidenced by serum albumin levels, did not differ significantly at baseline between those who had a decrease in frailty and those who did not. Previous studies have observed a lack of association between age and frailty in individuals with advanced HF . The present finding that age is not associated with a decrease in frailty after LVAD implantation further supports the concept that biological age is a more‐robust determinant of outcomes than chronological age …”

Section: Discussionsupporting

confidence: 87%

“…Previous studies have observed a lack of association between age and frailty in individuals with advanced HF. 34,35 The present finding that age is not associated with a decrease in frailty after LVAD implantation further supports the concept that biological age is a more-robust determinant of outcomes than chronological age. 37 The only parameter that was independently associated with a decrease in frailty was a higher baseline eGFR.…”

Section: Discussionsupporting

confidence: 80%

“…The decrease in frailty, which is highly prevalent in older adults with advanced HF, 34,35 was associated with improvement in quality of life, particularly in subscales related to symptom burden and frequency, which led to an improvement in the overall score. Decreases in frailty after LVAD were not associated with significant differences in measures of mood or cognition.…”

Section: Discussionmentioning

confidence: 92%

See 2 more Smart Citations

Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?

Maurer

Horn

Reyentovich

et al. 2017

J American Geriatrics Society

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Background/Objectives Frailty, characterized by decreased physiologic reserves, is strongly associated with vulnerability to adverse outcomes. Features of frailty overlap with those of advanced heart failure (HF), making a distinction between these phenotypes difficult. We sought to determine if implantation of a left ventricular assist device (LVAD) would improve the frailty phenotype. Design Prospective, cohort study Setting Five academic medical centers. Participants 29 frail subjects (age 70.6±5.5 years, 72.4% male) Measurements Frailty assessed prior to LVAD and at 1, 3 and 6 months post-LVAD and was defined as ≥3 Fried Frailty phenotype criteria. Other domains assessed included quality of life using the Kansas City Cardiomyopathy Questionnaire, mood using PHQ9, and cognitive function using trail maker B test Results After 6 months, 3 subjects died and 1 underwent a heart transplant; among 19 subjects with serial frailty measures, the average number of frailty criteria decreased from 3.9±0.9 at baseline to 2.8±1.4 at 6 months, p=0.003. Improvements were not observed until 3–6 months of support. However, 10 (52.6%) continued to meet ≥3 Fried criteria and all subjects met at least one at 6 months. Changes in the frailty phenotype were associated with improvement in QOL but not with changes in mood or cognition. eGFR at baseline was independently associated with improvement in frailty phenotype. Conclusions The frailty phenotype was improved in approximately 50% of older adults with advanced HF after 6 months of LVAD support. Strategies to enhance frailty reversal in this population are worthy of additional study.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?

Maurer

Horn

Reyentovich

et al. 2017

J American Geriatrics Society

View full text Add to dashboard Cite

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“…Frailty negatively affects HF management in elderly patients through impacting their self-care and indirectly by decreasing their enrollment in clinical trials. Despite the substantial overlap with typical HF symptoms such as exhaustion and reduced exertional capacity, formally assessed frailty predicts mortality and all-cause hospitalizations even in advanced HF patients who receive ventricular assist devices (40–42). The proposed mechanisms of frailty that intersect with findings in HF include chronic systemic inflammation with elevated levels of inflammatory markers (TNFα, IL-6, and C-reactive protein), hormonal and metabolic derangement resulting in anabolic-catabolic imbalance, and skeletal muscle weakness (43).…”

Section: Disability and Frailtymentioning

confidence: 99%

Heart Failure in Older Adults

Butrous

Hummel

2016

Canadian Journal of Cardiology

119

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Heart failure (HF) is a leading cause of morbidity, hospitalization, and mortality in older adults, and a growing public health problem placing a huge financial burden on the health care system. Many challenges exist in the assessment and management of HF in geriatric patients, who often have co-existing multi-morbid illness, polypharmacy, cognitive impairment, and frailty. These complex ‘geriatric domains’ greatly affect physical and functional status as well as long-term clinical outcomes. Geriatric patients have been under-represented in major HF clinical trials. Nonetheless, available data suggest that guideline-based medical and device therapies improve morbidity and mortality. Non-pharmacological strategies, such as exercise training and dietary interventions, are an active area of research. Targeted geriatric evaluation including functional and cognitive assessment can improve risk stratification and guide management in older HF patients. Clinical trials that enroll multi-morbid older HF patients and evaluate functional status and quality of life in addition to mortality and cardiovascular morbidity should be encouraged to guide management of this age group.

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“…26,27 Using the Fried Frailty Index in AHF patients aged 65 years or older, 65% were frail. 28 However, the criteria of weight loss may be confounded by fluid retention and the use of diuretics in the HF population. In addition, physical inactivity and exhaustion are common symptoms of HF patients, limiting their discriminatory ability in this population.…”

Section: Frailtymentioning

confidence: 99%

Left Ventricular Assist Device Therapy in Older Adults: Addressing Common Clinical Questions

DeFilippis

Nakagawa

Maurer

et al. 2019

J American Geriatrics Society

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OBJECTIVES To review the literature and summarize the evidence for left ventricular assist device (LVAD) use in older adults (aged >75 years), highlighting patient selection, day‐to‐day life with an LVAD, age‐specific complications, and end‐of‐life considerations. DESIGN Contemporary review of current literature on LVAD therapy in older adults. RESULTS There is a paucity of data on LVAD use and outcomes in adults older than 75 years and even less commonly are such devices implanted in those older than 80 years. Candidates and recipients of this age often have multiple chronic conditions and extracardiac impairments, which can negatively affect their short‐term outcomes and daily experience following LVAD implantation. Therefore, selection prior to implant should incorporate end‐organ function, nutritional status, measures of frailty, neurocognitive status, and social support, among others, to determine the patient population most likely to benefit from such therapy. CONCLUSION When LVAD therapy is utilized in an older adult, the needs for multidisciplinary team management and expertise in palliative care are essential. More age‐specific outcome data are required to help inform providers, patients, and caregivers. J Am Geriatr Soc 67:2410–2419, 2019

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Frailty Assessment in Advanced Heart Failure

Cited by 51 publications

References 14 publications

Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?

Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?

Heart Failure in Older Adults

Left Ventricular Assist Device Therapy in Older Adults: Addressing Common Clinical Questions

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