Advertisement

Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy

      Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Attisani M.
        • Centofanti P.
        • La Torre M.
        • Boffini M.
        • Ricci D.
        • Ribezzo M.
        • Baronetto A.
        • Rinaldi M.
        Advanced heart failure in critical patients (INTERMACS 1 and 2 levels): ventricular assist devices or emergency transplantation?.
        Interact Cardiovasc Thorac Surg. 2012; 15: 678-684
        • Pamboukian S.V.
        • Tallaj J.A.
        • Brown R.N.
        • Nielsen T.
        • George J.F.
        • Kirklin J.K.
        • Holman W.L.
        • Levy W.C.
        Comparison of observed survival after ventricular assist device placement versus predicted survival without assist device using the Seattle heart failure model.
        ASAIO J. 2012; 58: 93-97
        • Bonow R.O.
        • Bennett S.
        • Casey Jr, D.E.
        • Ganiats T.G.
        • Hlatky M.A.
        • Konstam M.A.
        • Lambrew C.T.
        • Normand S.L.
        • Pina I.L.
        • Radford M.J.
        • Smith A.L.
        • Stevenson L.W.
        • Bonow R.O.
        • Bennett S.J.
        • Burke G.
        • Eagle K.A.
        • Krumholz H.M.
        • Lambrew C.T.
        • Linderbaum J.
        • Masoudi F.A.
        • Normand S.L.
        • Ritchie J.L.
        • Rumsfeld J.S.
        • Spertus J.A.
        ACC/AHA clinical performance measures for adults with chronic heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.
        J Am Coll Cardiol. 2005; 46: 1144-1178
        • Krumholz H.M.
        • Keenan P.S.
        • Brush Jr, J.E.
        • Bufalino V.J.
        • Chernew M.E.
        • Epstein A.J.
        • Heidenreich P.A.
        • Ho V.
        • Masoudi F.A.
        • Matchar D.B.
        • Normand S.L.
        • Rumsfeld J.S.
        • Schuur J.D.
        • Smith Jr, S.C.
        • Spertus J.A.
        • Walsh M.N.
        Standards for measures used for public reporting of efficiency in health care: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes research and the American College of Cardiology Foundation.
        J Am Coll Cardiol. 2008; 52: 1518-1526
        • Dunlay S.M.
        • Park S.J.
        • Joyce L.D.
        • Daly R.C.
        • Stulak J.M.
        • McNallan S.M.
        • Roger V.L.
        • Kushwaha S.S.
        Frailty and outcomes after implantation of left ventricular assist device as destination therapy.
        J Heart Lung Transplant. 2014; 33: 359-365
        • Lee D.H.
        • Buth K.J.
        • Martin B.J.
        • Yip A.M.
        • Hirsch G.M.
        Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery.
        Circulation. 2010; 121: 973-978
        • Duscha B.D.
        • Kraus W.E.
        • Keteyian S.J.
        • Sullivan M.J.
        • Green H.J.
        • Schachat F.H.
        • Pippen A.M.
        • Brawner C.A.
        • Blank J.M.
        • Annex B.H.
        Capillary density of skeletal muscle: a contributing mechanism for exercise intolerance in class II-III chronic heart failure independent of other peripheral alterations.
        J Am Coll Cardiol. 1999; 33: 1956-1963
        • Jha S.R.
        • Hannu M.K.
        • Chang S.
        • Montgomery E.
        • Harkess M.
        • Wilhelm K.
        • Hayward C.S.
        • Jabbour A.
        • Spratt P.M.
        • Newton P.
        • Davidson P.M.
        • Macdonald P.S.
        The prevalence and prognostic significance of frailty in patients with advanced heart failure referred for heart transplantation.
        Transplantation. 2016; 100: 429-436
        • Mancini D.M.
        • Coyle E.
        • Coggan A.
        • Beltz J.
        • Ferraro N.
        • Montain S.
        • Wilson J.R.
        Contribution of intrinsic skeletal muscle changes to 31P NMR skeletal muscle metabolic abnormalities in patients with chronic heart failure.
        Circulation. 1989; 80: 1338-1346
        • Tacke M.
        • Ebner N.
        • Boschmann M.
        • Jarius A.
        • Valentova M.
        • Fulster S.
        • Sandek A.
        • Schomburg L.
        • Anker S.D.
        • Doehner W.
        • von Haehling S.
        Resting energy expenditure and the effects of muscle wasting in patients with chronic heart failure: results from the Studies Investigating Comorbidities Aggravating Heart Failure (SICA-HF).
        J Am Med Dir Assoc. 2013; 14: 837-841
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • Newman A.B.
        • Hirsch C.
        • Gottdiener J.
        • Seeman T.
        • Tracy R.
        • Kop W.J.
        • Burke G.
        • McBurnie M.A.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Joyce E.
        Frailty in advanced heart failure.
        Heart Fail Clin. 2016; 12: 363-374
        • Chung C.J.
        • Wu C.
        • Jones M.
        • Kato T.S.
        • Dam T.T.
        • Givens R.C.
        • Templeton D.L.
        • Maurer M.S.
        • Naka Y.
        • Takayama H.
        • Mancini D.M.
        • Schulze P.C.
        Reduced handgrip strength as a marker of frailty predicts clinical outcomes in patients with heart failure undergoing ventricular assist device placement.
        J Card Fail. 2014; 20: 310-315
        • Orme J.G.
        • Reis J.
        • Herz E.J.
        Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale.
        J Clin Psychol. 1986; 42: 28-33
        • Cesari M.
        • Penninx B.W.
        • Pahor M.
        • Lauretani F.
        • Corsi A.M.
        • Rhys Williams G.
        • Guralnik J.M.
        • Ferrucci L.
        Inflammatory markers and physical performance in older persons: the InCHIANTI study.
        J Gerontol A Biol Sci Med Sci. 2004; 59: 242-248
        • Schaap L.A.
        • Pluijm S.M.
        • Deeg D.J.
        • Harris T.B.
        • Kritchevsky S.B.
        • Newman A.B.
        • Colbert L.H.
        • Pahor M.
        • Rubin S.M.
        • Tylavsky F.A.
        • Visser M.
        Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength.
        J Gerontol A Biol Sci Med Sci. 2009; 64: 1183-1189
        • Barzilay J.I.
        • Blaum C.
        • Moore T.
        • Xue Q.L.
        • Hirsch C.H.
        • Walston J.D.
        • Fried L.P.
        Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study.
        Arch Intern Med. 2007; 167: 635-641
        • Travison T.G.
        • Nguyen A.H.
        • Naganathan V.
        • Stanaway F.F.
        • Blyth F.M.
        • Cumming R.G.
        • Le Couteur D.G.
        • Sambrook P.N.
        • Handelsman D.J.
        Changes in reproductive hormone concentrations predict the prevalence and progression of the frailty syndrome in older men: the concord health and ageing in men project.
        J Clin Endocrinol Metab. 2011; 96: 2464-2474
        • Anker S.D.
        • von Haehling S.
        Inflammatory mediators in chronic heart failure: an overview.
        Heart. 2004; 90: 464-470
        • Giagulli V.A.
        • Guastamacchia E.
        • De Pergola G.
        • Iacoviello M.
        • Triggiani V.
        Testosterone deficiency in male: a risk factor for heart failure.
        Endocr Metab Immune Disord Drug Targets. 2013; 13: 92-99
        • Vargas-Uricoechea H.
        • Bonelo-Perdomo A.
        • Sierra-Torres C.H.
        Effects of thyroid hormones on the heart.
        Clin Investig Arterioscler. 2014; 26: 296-309
        • Buchman A.S.
        • Boyle P.A.
        • Wilson R.S.
        • Tang Y.
        • Bennett D.A.
        Frailty is associated with incident Alzheimer's disease and cognitive decline in the elderly.
        Psychosom Med. 2007; 69: 483-489
        • Cohen M.B.
        • Mather P.J.
        A review of the association between congestive heart failure and cognitive impairment.
        Am J Geriatr Cardiol. 2007; 16: 171-174
        • Flint K.M.
        • Matlock D.D.
        • Lindenfeld J.
        • Allen L.A.
        Frailty and the selection of patients for destination therapy left ventricular assist device.
        Circ Heart Fail. 2012; 5: 286-293
        • Uchmanowicz I.
        • Loboz-Rudnicka M.
        • Szelag P.
        • Jankowska-Polanska B.
        • Loboz-Grudzien K.
        Frailty in heart failure.
        Curr Heart Fail Rep. 2014; 11: 266-273
        • Saji M.
        • Lim D.S.
        • Ragosta M.
        • LaPar D.J.
        • Downs E.
        • Ghanta R.K.
        • Kern J.A.
        • Dent J.M.
        • Ailawadi G.
        Usefulness of psoas muscle area to predict mortality in patients undergoing transcatheter aortic valve replacement.
        Am J Cardiol. 2016; 118: 251-257
        • Sepehri A.
        • Beggs T.
        • Hassan A.
        • Rigatto C.
        • Shaw-Daigle C.
        • Tangri N.
        • Arora R.C.
        The impact of frailty on outcomes after cardiac surgery: a systematic review.
        J Thorac Cardiovasc Surg. 2014; 148: 3110-3117
        • Purser J.L.
        • Kuchibhatla M.N.
        • Fillenbaum G.G.
        • Harding T.
        • Peterson E.D.
        • Alexander K.P.
        Identifying frailty in hospitalized older adults with significant coronary artery disease.
        J Am Geriatr Soc. 2006; 54: 1674-1681
        • Cowger J.
        • Sundareswaran K.
        • Rogers J.G.
        • Park S.J.
        • Pagani F.D.
        • Bhat G.
        • Jaski B.
        • Farrar D.J.
        • Slaughter M.S.
        Predicting survival in patients receiving continuous flow left ventricular assist devices: the HeartMate II risk score.
        J Am Coll Cardiol. 2013; 61: 313-321