Mathew S Maurer1, Evelyn Horn2, Alex Reyentovich3, Victoria Vaughan Dickson4, Sean Pinney5, Deena Goldwater6, Nathan E Goldstein7, Omar Jimenez1, Sergio Teruya8, Jeff Goldsmith9, Stephen Helmke1, Melana Yuzefpolskaya1, Gordon R Reeves10. 1. Clinical Cardiovascular Research Laboratory for the Elderly, Columbia University Medical Center, Allen Hospital of New York Presbyterian, New York, New York. 2. Weill Medical College of Cornell University, New York, New York. 3. New York University Langone Medical Center, New York, New York. 4. New York University, Meyers College of Nursing, New York, New York. 5. Icahn School of Medicine at Mount Sinai, New York, New York. 6. Cedars-Sinai Medical Center, Los Angeles, California. 7. Department of Geriatrics, Mount Sinai School of Medicine, New York, New York. 8. Medicine, Columbia University, New York, New York. 9. Biostatistics, Columbia University, New York, New York. 10. Thomas Jefferson University, Philadelphia, Pennsylvania.
Abstract
BACKGROUND/ OBJECTIVES: Frailty, characterized by low physiological reserves, is strongly associated with vulnerability to adverse outcomes. Features of frailty overlap with those of advanced heart failure, making a distinction between them difficult. We sought to determine whether implantation of a left ventricular assist device (LVAD) would decrease frailty. DESIGN: Prospective, cohort study. SETTING: Five academic medical centers. PARTICIPANTS: Frail individuals (N = 29; mean age 70.6 ± 5.5, 72.4% male). MEASUREMENTS: Frailty, defined as having 3 or more of the Fried frailty criteria, was assessed before LVAD implantation and 1, 3, and 6 months after implantation. Other domains assessed included quality of life, using the Kansas City Cardiomyopathy Questionnaire; mood, using the Patient Health Questionnaire; and cognitive function, using the Trail-Making Test Part B. RESULTS: After 6 months, three subjects had died, and one had undergone a heart transplant; of 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 = .003). Improvements were observed after 3 to 6 months of LVAD support, although 10 (52.6%) participants still had 3 or more Fried criteria, and all subjects had at least one at 6 months. Changes in frailty were associated with improvement in QOL but not with changes in mood or cognition. Higher estimated glomerular filtration rate at baseline was independently associated with a decrease in frailty. CONCLUSION: Frailty decreased in approximately half of older adults with advanced heart failure after 6 months of LVAD support. Strategies to enhance frailty reversal in this population are worthy of additional study.
BACKGROUND/ OBJECTIVES: Frailty, characterized by low physiological reserves, is strongly associated with vulnerability to adverse outcomes. Features of frailty overlap with those of advanced heart failure, making a distinction between them difficult. We sought to determine whether implantation of a left ventricular assist device (LVAD) would decrease frailty. DESIGN: Prospective, cohort study. SETTING: Five academic medical centers. PARTICIPANTS: Frail individuals (N = 29; mean age 70.6 ± 5.5, 72.4% male). MEASUREMENTS: Frailty, defined as having 3 or more of the Fried frailty criteria, was assessed before LVAD implantation and 1, 3, and 6 months after implantation. Other domains assessed included quality of life, using the Kansas City Cardiomyopathy Questionnaire; mood, using the Patient Health Questionnaire; and cognitive function, using the Trail-Making Test Part B. RESULTS: After 6 months, three subjects had died, and one had undergone a heart transplant; of 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 = .003). Improvements were observed after 3 to 6 months of LVAD support, although 10 (52.6%) participants still had 3 or more Fried criteria, and all subjects had at least one at 6 months. Changes in frailty were associated with improvement in QOL but not with changes in mood or cognition. Higher estimated glomerular filtration rate at baseline was independently associated with a decrease in frailty. CONCLUSION: Frailty decreased in approximately half of older adults with advanced heart failure after 6 months of LVAD support. Strategies to enhance frailty reversal in this population are worthy of additional study.
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