Frailty of the Heart Recipient

Abstract

Frailty has been defined as a state of increased vulnerability due to a decline in the reserve and function of multiple physiological systems. Initially conceived as a geriatric syndrome indicative of physiological aging, it is now apparent that frailty can also be observed as a manifestation of chronic disease states including heart failure. Estimates of the prevalence of frailty in heart failure vary according to the age of the study population and the frailty instrument used; however, multiple studies have identified frailty to be prevalent in patients with advanced heart failure including those who are referred for heart transplantation. Frailty is emerging as an independent predictor of mortality both before and after bridge-to-transplant ventricular assist device implantation and heart transplantation. Frailty is also predictive of prolonged hospitalization following these procedures. Heart failure–associated frailty is a dynamic state. While reversibility of frailty can be anticipated in younger heart failure patients, predicting the reversibility of frailty is more challenging in older patients who often have multiple comorbidities that may contribute to the frailty syndrome. Prehabilitation is a promising approach to both preventing and reversing frailty however more research is urgently needed to establish its effectiveness in mitigating the adverse impacts of frailty on postventricular assist device and posttransplant morbidity and mortality.

Feasibility of Virtual Assessment of Physical Frailty in Solid Organ Transplant Recipients – A Single Centre, Observational Study

“…Among the SOT recipients in this study, pre-frailty by the mFFI was present in 15 (44%) participants at 12 months post-transplant. This is similar in prevalence to the in-person assessment of physical frailty after lung, kidney, liver, or heart transplantation (Harhay et al, 2929; Jha et al, 2017 ; Lai et al, 2018 ; MacDonald, 2021 ; Varughese et al, 2020 ). The simple question about opening a jar may be an alternative to handgrip strength for evaluating muscle weakness remotely.…”

The role of frailty in advanced HF and cardiac transplantation

“…However, Dent et al have identified 29 different frailty measures and comprehensively reviewed those in common use as well as individual factors such as gait speed ( 31 ). Macdonald et al have also summarised those tools relevant to heart transplantation and failure ( 33 ). A new clinical measure called the “Frail Trait Scale” (FTS) is currently being evaluated as part of the FRAILTOOLs project and has been shown to be one of the best tools for predicting a range of adverse outcomes in older people across clinical settings ( 34 ).…”

“…It is important to note that frailty is a dynamic process in these complex patients. For example, non-frail patients prior to transplant who have major complications requiring a long hospital admission post-transplant are likely to become frail post-operatively ( 33 ).…”

“…Exercise reduces obesity, insulin resistance, blood pressure and overall cardiovascular disease risk ( 77 ). Prehabilitation, defined as the screening for and identification of pre-existing disorder followed by medical optimisation ( 78 ), is emerging as a useful tool for assessing patients prior to major cardiac surgery ( 33 ). In addition, exercise such as that incorporated in cardiac rehabilitation has been shown to improve prognosis and be excellent secondary prevention once a cardiac event has occurred ( 79 ).…”

Sarcopenia in Patients with End-Stage Cardiac Failure Requiring Ventricular Assist Device or Heart Transplantation

“…Several investigators reported improvement of HGS after implantation of CF-LVAD [21,22]. Although it has been reported that frailty prior to BTT LVAD implantation is associated with an increased post-LVAD morbidity and mortality, it has also been reported that frailty is reversible in most patients who survive the perioperative period [45,46]. Maurer et al [47] assessed reversal of frailty in 29 elderly frail LVAD recipients with a mean age of 71 years.…”