The Prevalence and Prognostic Significance of Frailty in Patients With Advanced Heart Failure Referred for Heart Transplantation

Jha, Sunita R; Hannu, M.; Chang, Sungwon; Montgomery, E. E.; Harkess, M.; Wilhelm, Kay; Hayward, Christopher; Jabbour, Andrew; Spratt, Phillip; Newton, Phillip J.; Davidson, Patricia M.; Macdonald, Peter S.

doi:10.1097/tp.0000000000000991

Cited by 146 publications

(171 citation statements)

References 34 publications

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“…The inability to rise from a chair and walk down the hall, much less complete any form of physical activity, is characteristic of impaired function in HF. Together with other studies in HF, 6,7 we also show evidence that cognitive function is significantly worse among physically frail patients with HF. Finally, the significant difference in 1-year projected survival is in line with other studies that have demonstrated worse clinical outcomes in frail patients with HF.…”

Section: Discussionsupporting

confidence: 86%

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Frequency of and Significance of Physical Frailty in Patients With Heart Failure

Denfeld

Winters-Stone

Mudd

et al. 2017

The American Journal of Cardiology

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Physical frailty is an important prognostic indicator in heart failure (HF); however, few studies have examined the relationship between physical frailty and invasive hemodynamics among adults with HF. The purpose of this study was to characterize physical frailty in HF in relation to invasive hemodynamics. We enrolled 49 patients with New York Heart Association (NYHA) Class II-IV HF when participants were scheduled for a right heart catheterization (RHC) procedure. Physical frailty was measured according to the Frailty Phenotype: shrinking, weakness, slowness, physical exhaustion, and low physical activity. Markers of invasive hemodynamics were derived from a formal review of RHC tracings, and projected survival was calculated using the Seattle HF Model (SHFM). The mean age of the sample (n = 49) was 57.4±9.7 years, 67% were male, 92% had NYHA Class III/IV HF, and 67% had non-ischemic HF. Physical frailty was identified in 24 participants (49%) and was associated with worse SHFM one-year projected survival (p = 0.007). After adjusting for projected survival, physically frail participants had lower cardiac index (by both thermodilution and the Fick equation) and higher heart rates compared with those not physically frail (all p < 0.05). In conclusion, physical frailty is highly prevalent in patients with HF and is associated with low-output HF.

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Section: Discussionsupporting

confidence: 86%

“…7-10,26 Our rates of physical frailty could be higher compared with other HF settings because our academic medical center is a referral site for advanced HF, and all participants required a clinically-indicated RHC procedure (e.g. to stage for advanced therapies).…”

Section: Discussionmentioning

confidence: 99%

Frequency of and Significance of Physical Frailty in Patients With Heart Failure

Denfeld

Winters-Stone

Mudd

et al. 2017

The American Journal of Cardiology

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“…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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“…Studies of frailty in HF have concentrated on elderly populations, including those being considered for invasive interventions, such as TAVR, ICD and DT-LVAD therapy [85,[104][105][106]. Symptoms of AdHF overlap considerably with the manifestations of frailty, including weakness, exercise intolerance, fatigue, exhaustion and cachexia [84,105,[107][108][109]. HF-related frailty and cardiac cachexia are similar if not the same phenotype [110,111].…”

Section: Frailty and Outcomesmentioning

confidence: 99%

A Peripheral Blood Transcriptome Biomarker Test to Diagnose Functional Recovery Potential in Advanced Heart Failure

Deng

2018

Biomark. Med.

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Heart failure (HF) is a complex clinical syndrome that causes systemic hypoperfusion and failure to meet the body's metabolic demands. In an attempt to compensate, chronic upregulation of the sympathetic nervous system and renin-angiotensin-aldosterone leads to further myocardial injury, HF progression and reduced O 2 delivery. This triggers progressive organ dysfunction, immune system activation and profound metabolic derangements, creating a milieu similar to other chronic systemic diseases and presenting as advanced HF with severely limited prognosis. We hypothesize that 1-year survival in advanced HF is linked to functional recovery potential (FRP), a novel clinical composite parameter that includes HF severity, secondary organ dysfunction, co-morbidities, frailty, disabilities as well as chronological age and that can be diagnosed by a molecular biomarker.

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The Prevalence and Prognostic Significance of Frailty in Patients With Advanced Heart Failure Referred for Heart Transplantation

Abstract: Frailty is prevalent among patients with advanced symptomatic heart failure referred for heart transplantation and is associated with increased mortality.

Cited by 146 publications

References 34 publications

Frequency of and Significance of Physical Frailty in Patients With Heart Failure

Frequency of and Significance of Physical Frailty in Patients With Heart Failure

Cognitive Impairment and Overall Survival in Frail Surgical Patients

A Peripheral Blood Transcriptome Biomarker Test to Diagnose Functional Recovery Potential in Advanced Heart Failure

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