8 Reversibility of frailty in LVAD and heart transplant patients

Frailty is a condition that is characterised by reduced physiological reserve. Multiple instruments have been developed to measure frailty mainly in community-dwelling elderly people.1 We have adapted one of these instruments, the Fried frailty phenotype, to assess frailty in patients with advanced heart failure (AHF) referred for consideration of ventricular assist device (VAD) implantation and/or heart transplantation (HTx). Since 2013, when possible all AHF patients referred to our centre have been assessed for frailty. Fried’s five physical domains – exhaustion, grip-strength, mobility, appetite and physical inactivity (frail ≥3/5), as well as cognitive impairment (MoCA ≤26) and depression (DMI >9) were assessed. We have demonstrated that frailty is associated with increased mortality in patients with AHF2 3 and increased morbidity and mortality after VAD implantation and after heart transplantation.4 Despite the increased morbidity and mortality post-intervention, physical frailty is reversible in the majority of patients undergoing bridge-to-transplant VAD implantation and HTx. Of the individual frailty domains, change in handgrip strength is the least sensitive indicator of improved frailty status. Future goals or challenges in frailty research in the setting of AHF include the development of a universally accepted frailty measurement, the development of measures that distinguish reversible from irreversible frailty, and the role of pre-habilitati...
Source: Heart Asia - Category: Cardiology Authors: Tags: Keynote Lecture Source Type: research