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Meece LE, Yu J, Winchester DE, Petersen M, Jeng EI, Al-Ani MA, Parker AM, Vilaro JR, Aranda JM, Ahmed MM. Prognostic Value of Frailty for Heart Failure Patients Undergoing Left Ventricular Assist Device Implantation: A Systematic Review. Cardiol Rev 2023; Publish Ahead of Print:00045415-990000000-00081. [PMID: 36881614 DOI: 10.1097/crd.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Frailty is associated with poor clinical outcomes in heart failure patients. The impact of frailty on outcomes following left ventricular assist device (LVAD) implantation, however, is less clearly defined. We therefore sought to conduct a systematic review to evaluate current frailty assessment strategies and their significance for patients undergoing LVAD implantation. We conducted a comprehensive electronic search of PubMed, Embase, and CINAHL databases from inception until April 2021 for studies examining frailty in patients undergoing LVAD implantation. Study characteristics, patient demographics, type of frailty measurement, and outcomes were extracted. Outcomes were organized into 5 basic categories: implant length of stay (iLOS), 1-year mortality, rehospitalization, adverse events, and quality of life (QOL). Of the 260 records retrieved, 23 studies involving 4935 patients satisfied the inclusion criteria. Approaches to measuring frailty varied, with the 2 most common being sarcopenia determined by computed tomography and Fried's frailty phenotype assessment. Outcomes of interest were also widely variable, with iLOS stay and mortality being the most frequently reported, albeit with differing definitions of both between studies. The heterogeneity among included studies precluded quantitative synthesis. Narrative synthesis showed that frailty by any measure is more likely to be associated with higher mortality, longer iLOS, more adverse events and worse QOL post-LVAD implant. Frailty can be a valuable prognostic indicator in patients undergoing LVAD implantation. Further studies are needed to determine the most sensitive frailty assessment, as well as the ways in which frailty may serve as a modifiable target to improve outcomes following LVAD implantation.
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Affiliation(s)
- Lauren E Meece
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Julia Yu
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - David E Winchester
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | | | - Eric I Jeng
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL
| | - Mohammad A Al-Ani
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Alex M Parker
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Juan R Vilaro
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Juan M Aranda
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Mustafa M Ahmed
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
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Ajibawo T, Chauhan P, Gopalan RS, Agarwal NK. The prognostic value of clinical frailty scale and outcomes in older patients undergoing left ventricular assist device implantation. Aging Med (Milton) 2022; 5:257-263. [PMID: 36606267 PMCID: PMC9805295 DOI: 10.1002/agm2.12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/15/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Heart failure impacts patients' functional capabilities, ultimately leading to frailty. The use of a left ventricular assist device (LVAD) is acceptable as both destination therapy and bridge to transplant in heart failure management. We aim to evaluate the prognostic value of the Clinical Frailty Scale (CFS) on outcomes in older patients undergoing implantation of LVAD. Methods We conducted a retrospective chart review of patients ≥ 60 years old that underwent LVAD implantation at our medical center from May 1, 2018, to October 30, 2020. CFS was retrospectively assigned before LVAD placement and CFS scores > 4 was considered frail. Kaplan-Meier curves and Cox regression were used to analyze 1-year survival estimates. Results Forty percent of the cohort was classified as frail according to CFS. Thirty-day re-admission rates were comparable between frail and non-frail patients (46% vs 35%; P = 0.419). 1-year survival was lower in the frail vs non-frail group (log rank, P = 0.017). On Cox analysis, only frailty was associated with 1-year post-intervention mortality (hazard ratio [HR] = 5.64, 95% confidence interval [CI] = 1.131-28.212; P = 0.035). Conclusions CFS-defined frailty was associated with increased risk of 1-year mortality after LVAD implantation. CFS may be a valuable tool in the frailty assessment for risk stratification of patients undergoing LVAD implantation. Multicenter studies are required to validate these findings.
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Affiliation(s)
- Temitope Ajibawo
- Division of Geriatric Medicine, Department of Internal MedicineBanner University Medical CenterPhoenixArizonaUSA
| | - Priyank Chauhan
- Division of Geriatric Medicine, Department of Internal MedicineBanner University Medical CenterPhoenixArizonaUSA
| | - Radha S. Gopalan
- Division of Cardiology, Department of Internal MedicineBanner University Medical CenterPhoenixArizonaUSA
| | - Nimit K. Agarwal
- Division of Geriatric Medicine, Department of Internal MedicineBanner University Medical CenterPhoenixArizonaUSA
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Tse G, Gong M, Wong SH, Wu WKK, Bazoukis G, Lampropoulos K, Wong WT, Xia Y, Wong MCS, Liu T, Woo J. Frailty and Clinical Outcomes in Advanced Heart Failure Patients Undergoing Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2017; 19:255-261.e1. [PMID: 29129497 DOI: 10.1016/j.jamda.2017.09.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Frailty has been identified as a risk factor for adverse clinical outcomes after cardiac intervention or surgery. However, whether it increases the risk of adverse outcomes in patients undergoing left ventricular assist device (LVAD) therapy has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and clinical outcomes of length of stay and mortality in this setting. METHODS PubMed and Embase were searched until September 11, 2017, for studies evaluating the association between frailty and clinical outcomes in advanced heart failure patients undergoing LVAD implantation. RESULTS A total of 46 and 79 entries were retrieved from our search strategy. A total of 13 studies involving 3435 patients were included in the final meta-analysis (mean age: 57.7 ± 15.3 years; 79% male, follow-up duration was 13 ± 14 months). Compared to nonfrail patients (n = 2721), frail patients (n = 579) had significantly longer time-to-extubation (n = 3; mean difference: 45 ± 6 hours; I2: 0%) and hospital length of stay (n = 4; mean difference: 2.9 ± 1.2 days; P = .001; I2: 21%). Frailty was not a predictor of inpatient or short-term mortality [n = 3; hazard ratio (HR): 1.22, 95% confidence interval (CI): 0.66-2.26; P > .05; I2: 0%] but predicted long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P = .001; I2: 0%). CONCLUSIONS Frailty leads to significantly longer time to extubation, hospital length of stay, and long-term mortality in advanced heart failure patients who have undergone LVAD implantation. Older patients being considered for LVAD implantation should therefore be assessed for frailty status. The risk and benefit of the procedure should be explained to the patient, emphasizing that frailty increases the likelihood of adverse clinical outcomes.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Sunny Hei Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - William K K Wu
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China; Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos Lampropoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China; State Key Laboratory of Digestive Disease, Chinese University of Hong Kong
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
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