The prognostic significance of frailty compared to peak oxygen consumption and B‐type natriuretic peptide in patients with advanced heart failure

Abstract

Frailty assessment has become an integral part of the evaluation of potential candidates for heart transplantation and ventricular assist device (HTx/VAD). The impact of frailty, as a heart failure risk factor or to identify those who will derive the greatest benefit with HTx/VAD remains unclear. The aim of this study was to evaluate the independent prognostic relevance of frailty assessment from peak oxygen consumption (peak VO ) or B-type natriuretic peptide (BNP) on mortality in patients referred for advanced heart failure therapies. Frailty was measured using modified Fried frailty criteria. In 201 consecutive patients, during a median follow-up of 17.5 months (IQR 11-29.2), there were 25 (12.4%) deaths. One-year survival was 100%, 94%, and 78% in nonfrail, prefrail, and frail patients, respectively (log rank P = .0001). Frailty was associated with a twofold increase risk of death (HR 2.01, P < .0001, 95% CI 1.42-2.84). When adjusted for BNP or peak VO , frailty was not associated with a significant risk of all-cause death. However, when peak VO is stratified into two categories (≥12 mL/kg/min vs <12 mL/kg/min), frailty was associated with increased mortality in patients with a lower peak VO (HR 1.72, P = .006).

Heart Failure and Problems with Frailty Syndrome: Why it is Time to Care About Frailty Syndrome in Heart Failure

“…Moayedi et al showed that, adjusted for B-type natriuretic peptide or peak oxygen consumption (VO 2 ), frailty identified using the phenotype of frailty was not associated with increased mortality in people with advanced HF. [80] However, Moayedi et al also found that when peak VO 2 was stratified into two categories (≥12 ml/kg/min versus <12 ml/kg/min), frailty was associated with a 72% higher risk of death in this group. [80] Of the individual phenotype of frailty components, low physical activity assessed with the Duke Activity Status Index was associated with the highest risk of death.…”

“…[80] However, Moayedi et al also found that when peak VO 2 was stratified into two categories (≥12 ml/kg/min versus <12 ml/kg/min), frailty was associated with a 72% higher risk of death in this group. [80] Of the individual phenotype of frailty components, low physical activity assessed with the Duke Activity Status Index was associated with the highest risk of death. [81,82] A study by Martin-Sánchez et al showed that the presence of physical frailty in people with moderate disability has an impact on 30–day mortality in people ≥65 years with acute decompensated HF attending an emergency department.…”

Impact of pretransplant recipient body mass index on post heart transplant mortality: A systematic review and meta‐analysis

“…16 In heart transplant recipients, those who developed deep-sternal wound infection post-transplant were more likely to be obese (46% and 17% obesity in patients with and without deep-sternal wound infection, respectively), 17 potentially increasing the risk of mortality due to infection. 23 Low BMI is likely a marker for an increased prevalence of frailty. 19 The ISHLT registry has shown that long-term survival postheart transplant is significantly lower in diabetic patients compared to those without diabetes (12% reduction in survival by 10-year post-transplant).…”

“…22 Among the individual domains used to assess frailty, unintentional weight loss is a strong predictor of mortality in patients with advanced heart failure (HR 2.55, 95% CI 1.16-5.62). 23 A recent case series suggests 26% of patients undergoing advanced therapies for heart failure (heart transplant or ventricular assist device implantation), die within the index hospital admission or within 30-days post operation, all of whom were classified as frail or prefrail. 23 Low BMI is likely a marker for an increased prevalence of frailty.…”

“…23 A recent case series suggests 26% of patients undergoing advanced therapies for heart failure (heart transplant or ventricular assist device implantation), die within the index hospital admission or within 30-days post operation, all of whom were classified as frail or prefrail. 23 Low BMI is likely a marker for an increased prevalence of frailty. Hence it may be the reduced physiologic reserve caused by frailty that explains the increased risk of mortality in patients with an underweight BMI.…”