Prognostic Value of Frailty for Heart Failure Patients Undergoing Left Ventricular Assist Device Implantation: A Systematic Review

Abstract

Frailty is associated with poor clinical outcomes in heart failure patients. The impact of frailty on outcomes following left ventricular assist device (LVAD) implantation, however, is less clearly defined. We therefore sought to conduct a systematic review to evaluate current frailty assessment strategies and their significance for patients undergoing LVAD implantation. We conducted a comprehensive electronic search of PubMed, Embase, and CINAHL databases from inception until April 2021 for studies examining frailty in patients undergoing LVAD implantation. Study characteristics, patient demographics, type of frailty measurement, and outcomes were extracted. Outcomes were organized into 5 basic categories: implant length of stay (iLOS), 1-year mortality, rehospitalization, adverse events, and quality of life (QOL). Of the 260 records retrieved, 23 studies involving 4935 patients satisfied the inclusion criteria. Approaches to measuring frailty varied, with the 2 most common being sarcopenia determined by computed tomography and Fried's frailty phenotype assessment. Outcomes of interest were also widely variable, with iLOS stay and mortality being the most frequently reported, albeit with differing definitions of both between studies. The heterogeneity among included studies precluded quantitative synthesis. Narrative synthesis showed that frailty by any measure is more likely to be associated with higher mortality, longer iLOS, more adverse events and worse QOL post-LVAD implant. Frailty can be a valuable prognostic indicator in patients undergoing LVAD implantation. Further studies are needed to determine the most sensitive frailty assessment, as well as the ways in which frailty may serve as a modifiable target to improve outcomes following LVAD implantation.

Prehabilitation Maximizing Functional Mobility in Patients With Cardiogenic Shock Supported on Axillary Impella

“…9,16 Frailty is a significant component in patients with heart failure, and data suggest a strong association between frailty and worse clinical outcomes. 5,16 Patients presenting with acute on chronic decompensation frequently have significant end-organ dysfunction, which may deem them high-risk or ineligible for advanced therapies at the time of presentation. 17 However, once bridged with tMCS, these patients can undergo protocolized PT and nutritional intervention, helping them gain muscle mass and strength.…”

“…Additionally, frailty and poor nutritional status are associated with poor outcomes after dLVAD placement. 5 When presented to the medical review board, these patients were historically denied advanced therapy, with palliative care as the only option. However, the use of trans-aortic axillary Impellas (5.0, 5.5; Abiomed, Danvers, MA) in critically ill patients with clinical CS has the potential to reverse the end-organ damage and improve their nutritional and functional status.…”