Benefits of both physical assessment and electronic health record review to assess frailty prior to heart transplant

Abstract

Introduction Frailty status affects outcomes after heart transplantation, but the optimal way to assess frailty prior to transplant remains unknown. Methods This single‐center, observational study assessed 44 heart transplant candidates for frailty using three methods. The Short Physical Performance Battery (SPPB) and Fried Frailty Phenotype (FFP) were used as two physical assessments of frailty. The Frailty Risk Score (FRS) was used as a chart‐review based assessment measuring 20 different biopsychosocial and functional components, including biomarkers, depression, cognitive impairment, and sleep. Results We determined the correlation between FRS, SPPB, and FFP and how each correlated with clinical outcomes. Of 44 participants, mean age was 60 years. FRS correlated with SPPB and FFP (P = .043, P < .001, respectively). Higher frailty as measured by SPPB and FRS was significantly associated with lack of achieving waitlist status (P = .022; P = .002) and not being transplanted (P = .026; P = .008). Higher frailty by SPPB and FFP was also associated with mortality (P = .010; P = .025). Conclusion SPPB and chart‐review FRS showed potential for predicting waitlist and transplant status of heart transplant candidates, while SPPB and FFP were associated with mortality. Additional studies may serve to validate these observations.

Frailty and solid-organ transplant candidates: a scoping review

“…The majority of studies were conducted in kidney (36 studies; [14,19,20,) and liver (36 studies; [15,) transplant candidates. Nine studies [93][94][95][96][97][98][99][100][101] and 16 studies [102][103][104][105][106][107][108][109][110][111][112][113][114][115][116][117] were conducted in heart and lung transplant candidates, respectively. Four studies [118][119][120][121] included double organ transplant candidates (i.e., kidney and liver transplant candidates or heart).…”

Biopsychosocial frailty and mild cognitive impairment subtypes: Findings from the Italian project on the epidemiology of Alzheimer's disease (IPREA)

“…4 Given the multisystem and multidimensional nature of the biological changes underpinning the frail condition, among frailty phenotypes, the multiconcept biopsychosocial frailty may be of greater importance in predicting cognitive-related adverse outcomes in older age, however, at present, this model is not fully operationalized. 8 In fact, some hospital- 32,33 and population-based 34 findings suggested the biopsychosocial frailty phenotype as a predictor of adverse health-related outcomes, including functional disability, institutionalization, and mortality. For cognitive-related adverse outcomes, some longitudinal population-based studies investigated the risk of incident all-cause dementia 4,[35][36][37][38] or AD.…”

Bioimpedance Spectroscopy in Heart Transplantation: Posttransplant Changes in Body Composition and Effects in Outcomes

“…Chief among these factors is appropriate patient selection, 1 whereby patients with marginal physiologic reserve, severe frailty, or advanced degrees of malnutrition are not suitable candidates for transplantation unless these characteristics can be optimized. 2,3 Unfortunately, little data exist on precisely which objective besides assessments are most accurate and predictive of subsequent adverse events. Assessment of frailty or nutrition status is heterogeneously practiced across centers and still largely predicated on invalid or crude parameters, such as serum albumin levels or body mass index (BMI).…”