Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation

Jha, Sunita R; Hannu, M.; Gore, Keren; Chang, Sungwon; Newton, Phillip J.; Wilhelm, Kay; Hayward, Christopher; Jabbour, Andrew; Kotlyar, Eugene; Keogh, Anne; Dhital, K.; Granger, Emily; Jansz, P.; Spratt, Phillip; Montgomery, E. E.; Harkess, M.; Tunicliff, Peta; Davidson, Patricia M.; Macdonald, Peter S.

doi:10.1016/j.healun.2016.04.008

Cited by 92 publications

(102 citation statements)

References 18 publications

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“…Frailty has traditionally been considered a geriatric syndrome; but, the lack of a relationship between age and frailty in HF indicates frailty in HF is not confined to older adults. In fact, frailty is high even among studies with younger HF patients (3, 33). As mentioned by previous reviews (16), the high prevalence of frailty in younger patients indicates we should consider frailty in HF at all ages rather than as a strict geriatric syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Moving forward, more research is needed to rigorously test and refine frailty measures to generate the most precise and accurate measure of frailty in HF. There is also a need to disambiguate the relationship between physical frailty and related concepts such as cognitive function and psychosocial health in order to improve the predictive ability of frailty, as recently studied by Jha et al (33). …”

Section: Discussionmentioning

confidence: 99%

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The prevalence of frailty in heart failure: A systematic review and meta-analysis

Denfeld

Winters-Stone

Mudd

et al. 2017

International Journal of Cardiology

289

196

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Background There is a growing interest in the intersection of heart failure (HF) and frailty; however, estimates of the prevalence of frailty in HF vary widely. The purpose of this paper was to quantitatively synthesize published literature on the prevalence of frailty in HF and to examine the relationship between study characteristics (i.e. age and functional class) and the prevalence of frailty in HF. Methods The prevalence of frailty in HF, divided into Physical Frailty and Multidimensional Frailty measures, was synthesized across published studies using a random-effects meta-analysis of proportions approach. Meta-regression was performed to examine the influence of age and functional class (at the level of the study) on the prevalence of frailty. Results A total of 26 studies involving 6896 patients with HF were included in this meta-analysis. Despite considerable differences across studies, the overall estimated prevalence of frailty in HF was 44.5% (95% Confidence Interval, 36.2%–52.8%; z = 10.54; p < 0.001). The prevalence was slightly lower among studies using Physical Frailty measures (42.9%, z = 9.05; p < 0.001) and slightly higher among studies using Multidimensional Frailty measures (47.4%, z = 5.66; p < 0.001). There were no significant relationships between study age or functional class and prevalence of frailty. Conclusions Frailty affects almost half of patients with HF and is not necessarily a function of age or functional classification. Future work should focus on standardizing the measurement of frailty and on broadening the view of frailty beyond a strictly geriatric syndrome in HF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The prevalence of frailty in heart failure: A systematic review and meta-analysis

Denfeld

Winters-Stone

Mudd

et al. 2017

International Journal of Cardiology

289

196

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“…3 In our previous studies of frailty in patients referred for HTx, frailty was reflective of increased vulnerability and was associated with an increased waitlist mortality and adverse postinterventional outcomes. 3,4 …”

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confidence: 99%

Reversibility of Frailty After Bridge-to-Transplant Ventricular Assist Device Implantation or Heart Transplantation

Jha

Hannu

Newton

et al. 2017

Transplantation Direct

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BackgroundWe recently reported that frailty is independently predictive of increased mortality in patients with advanced heart failure referred for heart transplantation (HTx). The aim of this study was to assess the impact of frailty on short-term outcomes after bridge-to-transplant ventricular assist device (BTT-VAD) implantation and/or HTx and to determine if frailty is reversible after these procedures.MethodsBetween August 2013 and August 2016, 100 of 126 consecutive patients underwent frailty assessment using Fried’s Frailty Phenotype before surgical intervention: 40 (21 nonfrail, 19 frail) BTT-VAD and 77 (60 nonfrail, 17 frail) HTx—including 17 of the 40 BTT-VAD supported patients. Postprocedural survival, intubation time, intensive care unit, and hospital length of stay were compared between frail and nonfrail groups. Twenty-six frail patients were reassessed at 2 months or longer postintervention.ResultsFrail patients had lower survival (63 ± 10% vs 94 ± 3% at 1 year, P = 0.012) and experienced significantly longer intensive care unit (11 vs 5 days, P = 0.002) and hospital (49 vs 25 days, P = 0.003) length of stay after surgical intervention compared with nonfrail patients. Twelve of 13 frail patients improved their frailty score after VAD (4.0 ± 0.8 to 1.4 ± 1.1, P < 0.001) and 12 of 13 frail patients improved their frailty score after HTx (3.2 ± 0.4 to 0.9 ± 0.9, P < 0.001). Handgrip strength and depression improved postintervention. Only a slight improvement in cognitive function was seen postintervention.ConclusionsFrail patients with advanced heart failure experience increased mortality and morbidity after surgical intervention with BTT-VAD or HTx. Among those who survive frailty is partly or completely reversible underscoring the importance of considering this factor as a dynamic not fixed entity.

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“…Previous studies only investigated the effect of physical frailty and cognitive impairment in one type of procedure or surgical discipline. 21,24 However, our results indicate these findings apply to a large portion of surgical patients beyond these specific areas. Our study is unique for being the first to use the CDT as a surrogate for cognitive impairment and combine it with the Fried frailty criteria to create a 4-level composite frailty scoring system.…”

Section: Discussionmentioning

confidence: 56%

“…However, the interconnected relationship between a human’s physical and mental statuses has stimulated interest to create a more comprehensive concept of frailty. 7,21,24–27 In our aging population, the accelerated risks of accumulating physical and mental deficits have been valuable and offer support for the concept of cognitive frailty. 12,28 Data from the French Three-City study indicated that considering the cognition domain in the frailty phenotype improved the identification of frail persons at risk for adverse health outcomes in the French community-dwelling population aged 65 to 95 years during 4 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Impairment and Overall Survival in Frail Surgical Patients

Makhani

Kim

Liu

et al. 2017

Journal of the American College of Surgeons

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BACKGROUND The definition of frailty, as modeled by the Fried criteria, has been limited primarily to the physical domain. The purpose of this study was to assess the additive value of cognitive function with existing frailty criteria to predict poor postoperative outcomes in a large multidisciplinary cohort of patients undergoing major operations. STUDY DESIGN A 4-level composite frailty scoring system was created via the combination of the Fried frailty score and the Emory Clock Draw Test to assess preoperative frailty and cognitive impairment, respectively. Overall survival was defined as months from date of operation to date of death or last follow-up. RESULTS This study included 330 patients undergoing major operations; mean age was 58 years and a total of 53 patient deaths occurred during 4-year follow-up. Among the robust cohort, 20 of 168 patients died (11.9%), and among those who were both physically frail and cognitively impaired, 11 of 26 patients died (42.3%). Multivariable analysis demonstrated the physically frail and cognitively impaired cohort to have a 3.92 higher risk of death (95% CI 1.66 to 9.26) compared with the cohort of robust patients (p = 0.002). Kaplan-Meier survival curves reveal an overall difference in long-term survival (log-rank p < 0.0001), driven mainly by the high risk of mortality among patients with both physical frailty and cognitive impairment. CONCLUSIONS The use of a combined frailty and cognitive assessment score has a more powerful potential to predict adult patients at higher risk of overall survival than either measurement alone. The addition of cognitive assessment to physical frailty measure can lead to improved preoperative decision making and possibly early intervention, as well as more accurate patient counseling.

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Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation

Cited by 92 publications

References 18 publications

The prevalence of frailty in heart failure: A systematic review and meta-analysis

The prevalence of frailty in heart failure: A systematic review and meta-analysis

Reversibility of Frailty After Bridge-to-Transplant Ventricular Assist Device Implantation or Heart Transplantation

Cognitive Impairment and Overall Survival in Frail Surgical Patients

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