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

Jha, SR; Hannu, MK; Chang, S; Montgomery, E; Harkess, M; Wilhelm, K; Hayward, CS; Jabbour, A; Spratt, PM; Newton, P; Davidson, PM; MacDonald, PS

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

Jha, SR

Hannu, MK Chang, S

Montgomery, E

Harkess, M Wilhelm, K Hayward, CS Jabbour, A Spratt, PM Newton, P

Davidson, PM

MacDonald, PS

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Publication Type:: Journal Article
Citation:: Transplantation, 2016, 100 (2), pp. 429 - 436
Issue Date:: 2016-02-01

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Field	Value	Language
dc.contributor.author	Jha, SR https://orcid.org/0000-0003-2819-0216	en_US
dc.contributor.author	Hannu, MK	en_US
dc.contributor.author	Chang, S https://orcid.org/0000-0003-0723-3192	en_US
dc.contributor.author	Montgomery, E https://orcid.org/0000-0003-3470-6901	en_US
dc.contributor.author	Harkess, M	en_US
dc.contributor.author	Wilhelm, K	en_US
dc.contributor.author	Hayward, CS	en_US
dc.contributor.author	Jabbour, A	en_US
dc.contributor.author	Spratt, PM	en_US
dc.contributor.author	Newton, P https://orcid.org/0000-0002-5006-2037	en_US
dc.contributor.author	Davidson, PM https://orcid.org/0000-0003-2050-1534	en_US
dc.contributor.author	MacDonald, PS	en_US
dc.date.issued	2016-02-01	en_US
dc.identifier.citation	Transplantation, 2016, 100 (2), pp. 429 - 436	en_US
dc.identifier.issn	0041-1337	en_US
dc.identifier.uri	http://hdl.handle.net/10453/90354
dc.description.abstract	Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Background Frailty is a clinically recognized syndrome of decreased physiological reserve. The heightened state of vulnerability in these patients confers a greater risk of adverse outcomes after even minor stressors. Our aim was to assess the prevalence and prognostic significance of the frailty phenotype in patients referred for heart transplantation. Methods Consecutive patients referred or on the waiting list for heart transplantation from March 2013 underwent frailty assessment. Frailty was defined as a positive response to 3 or more of the following 5 components: weak grip strength, slowed walking speed, poor appetite, physical inactivity, and exhaustion. In addition, markers of disease severity were obtained, and all patients underwent cognitive (Montreal Cognitive Assessment) and depression (Depression in Medical Illness-10) screening. Results One hundred twenty patients (83 men:37 women; age, 53 ± 12 years, range, 16-73 years; left ventricular ejection fraction, 27 ± 14%) underwent frailty assessment. Thirty-nine of 120 patients (33%) were assessed as frail. Frailty was associated with New York Heart Association class IV heart failure, lower body mass index, elevated intracardiac filling pressures, lower cardiac index, anemia, hypoalbuminemia, hyperbilirubinemia, cognitive impairment, and depression (all ρ < 0.05). Frailty was independent of age, sex, heart failure duration, left ventricular ejection fraction, or renal function. Frailty was an independent predictor of increased all-cause mortality: 1 year actuarial survival was 79 ± 5% in the nonfrail group compared with only 54 ± 9% for the frail group (P < 0.005). Conclusions Frailty is prevalent among patients with advanced symptomatic heart failure referred for heart transplantation and is associated with increased mortality.	en_US
dc.relation.ispartof	Transplantation	en_US
dc.relation.isbasedon	10.1097/TP.0000000000000991	en_US
dc.subject.classification	Surgery	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Prognosis	en_US
dc.subject.mesh	Heart Transplantation	en_US
dc.subject.mesh	Severity of Illness Index	en_US
dc.subject.mesh	Prevalence	en_US
dc.subject.mesh	Proportional Hazards Models	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Age Factors	en_US
dc.subject.mesh	Health Status	en_US
dc.subject.mesh	Phenotype	en_US
dc.subject.mesh	Patient Selection	en_US
dc.subject.mesh	Time Factors	en_US
dc.subject.mesh	Adolescent	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Frail Elderly	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Waiting Lists	en_US
dc.subject.mesh	Referral and Consultation	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Heart Failure	en_US
dc.subject.mesh	Young Adult	en_US
dc.subject.mesh	Kaplan-Meier Estimate	en_US
dc.title	The Prevalence and Prognostic Significance of Frailty in Patients with Advanced Heart Failure Referred for Heart Transplantation	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	100	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1104 Complementary and Alternative Medicine	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Nursing
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	100	en_US

Abstract:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Background Frailty is a clinically recognized syndrome of decreased physiological reserve. The heightened state of vulnerability in these patients confers a greater risk of adverse outcomes after even minor stressors. Our aim was to assess the prevalence and prognostic significance of the frailty phenotype in patients referred for heart transplantation. Methods Consecutive patients referred or on the waiting list for heart transplantation from March 2013 underwent frailty assessment. Frailty was defined as a positive response to 3 or more of the following 5 components: weak grip strength, slowed walking speed, poor appetite, physical inactivity, and exhaustion. In addition, markers of disease severity were obtained, and all patients underwent cognitive (Montreal Cognitive Assessment) and depression (Depression in Medical Illness-10) screening. Results One hundred twenty patients (83 men:37 women; age, 53 ± 12 years, range, 16-73 years; left ventricular ejection fraction, 27 ± 14%) underwent frailty assessment. Thirty-nine of 120 patients (33%) were assessed as frail. Frailty was associated with New York Heart Association class IV heart failure, lower body mass index, elevated intracardiac filling pressures, lower cardiac index, anemia, hypoalbuminemia, hyperbilirubinemia, cognitive impairment, and depression (all ρ < 0.05). Frailty was independent of age, sex, heart failure duration, left ventricular ejection fraction, or renal function. Frailty was an independent predictor of increased all-cause mortality: 1 year actuarial survival was 79 ± 5% in the nonfrail group compared with only 54 ± 9% for the frail group (P < 0.005). Conclusions Frailty is prevalent among patients with advanced symptomatic heart failure referred for heart transplantation and is associated with increased mortality.

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http://hdl.handle.net/10453/90354