Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation

Jha, SR; Hannu, MK; Gore, K; Chang, S; Newton, P; Wilhelm, K; Hayward, CS; Jabbour, A; Kotlyar, E; Keogh, A; Dhital, K; Granger, E; Jansz, P; Spratt, PM; Montgomery, E; Harkess, M; Tunicliff, P; Davidson, PM; Macdonald, PS

Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation

Jha, SR

Hannu, MK Gore, K Chang, S

Newton, P

Wilhelm, K Hayward, CS Jabbour, A Kotlyar, E Keogh, A Dhital, K Granger, E Jansz, P Spratt, PM Montgomery, E

Harkess, M Tunicliff, P Davidson, PM

Macdonald, PS

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Publication Type:: Journal Article
Citation:: Journal of Heart and Lung Transplantation, 2016, 35 (9), pp. 1092 - 1100
Issue Date:: 2016-09-01

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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	Gore, K	en_US
dc.contributor.author	Chang, S https://orcid.org/0000-0003-0723-3192	en_US
dc.contributor.author	Newton, P https://orcid.org/0000-0002-5006-2037	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	Kotlyar, E	en_US
dc.contributor.author	Keogh, A	en_US
dc.contributor.author	Dhital, K	en_US
dc.contributor.author	Granger, E	en_US
dc.contributor.author	Jansz, P	en_US
dc.contributor.author	Spratt, PM	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	Tunicliff, P	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.available	2016-04-25	en_US
dc.date.issued	2016-09-01	en_US
dc.identifier.citation	Journal of Heart and Lung Transplantation, 2016, 35 (9), pp. 1092 - 1100	en_US
dc.identifier.issn	1053-2498	en_US
dc.identifier.uri	http://hdl.handle.net/10453/92762
dc.description.abstract	© 2016 International Society for Heart and Lung Transplantation Background The aim of this study was to identify whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty provides better outcome prediction in patients with advanced heart failure referred for heart transplantation (HT). Methods Beginning in March 2013, all patients with advanced heart failure referred to our Transplant Unit have undergone a physical frailty assessment using the Fried frailty phenotype. Cognition was assessed with the Montreal Cognitive Assessment and depression with the Depression in Medical Illness questionnaire. We assessed the value of 4 composite frailty measures: physical frailty (PF ≥ 3 of 5 = frailty), “cognitive frailty” (CogF ≥ 3 of 6 = frail), “depressive frailty” (DepF ≥ 3 of 6 = frail), and “cognitive-depressive frailty” (ComF ≥ 3 of 7 = frail) in predicting outcomes. Results Frailty was assessed in 156 patients (109 men, 47 women), aged 53 ± 13 years, and with a left ventricular ejection fraction of 27% ± 14%. Inclusion of cognitive impairment or depression in the definition of frailty increased the proportion classified as frail from 33% using PF to 42% using ComF. During follow-up, 28 patients died before ventricular assist device implantation or HT. Frailty was associated with significantly lower ventricular assist device- and HT-free survival, with CogF best capturing early mortality: 12-month survival for non-frail and frail cohorts was 81% ± 5% vs 58% ± 10% (p < 0.02) using PF and 85% ± 5% vs 56% ± 9% (p < 0.002) using CogF. Combining the Depression in Medical Illness score with PF or CogF did not strengthen the relationship between frailty and mortality. Conclusions The addition of cognitive impairment to the assessment of PF strengthened its capacity to identify advanced heart failure patients referred for HT who are at high risk of early death.	en_US
dc.relation.ispartof	Journal of Heart and Lung Transplantation	en_US
dc.relation.isbasedon	10.1016/j.healun.2016.04.008	en_US
dc.subject.classification	Surgery	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Heart Transplantation	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Frail Elderly	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Heart Failure	en_US
dc.subject.mesh	Cognitive Dysfunction	en_US
dc.subject.mesh	Frailty	en_US
dc.title	Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation	en_US
dc.type	Journal Article
utslib.citation.volume	9	en_US
utslib.citation.volume	35	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1102 Cardiorespiratory Medicine and Haematology	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	9	en_US
pubs.publication-status	Published	en_US
pubs.volume	35	en_US

Abstract:

© 2016 International Society for Heart and Lung Transplantation Background The aim of this study was to identify whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty provides better outcome prediction in patients with advanced heart failure referred for heart transplantation (HT). Methods Beginning in March 2013, all patients with advanced heart failure referred to our Transplant Unit have undergone a physical frailty assessment using the Fried frailty phenotype. Cognition was assessed with the Montreal Cognitive Assessment and depression with the Depression in Medical Illness questionnaire. We assessed the value of 4 composite frailty measures: physical frailty (PF ≥ 3 of 5 = frailty), “cognitive frailty” (CogF ≥ 3 of 6 = frail), “depressive frailty” (DepF ≥ 3 of 6 = frail), and “cognitive-depressive frailty” (ComF ≥ 3 of 7 = frail) in predicting outcomes. Results Frailty was assessed in 156 patients (109 men, 47 women), aged 53 ± 13 years, and with a left ventricular ejection fraction of 27% ± 14%. Inclusion of cognitive impairment or depression in the definition of frailty increased the proportion classified as frail from 33% using PF to 42% using ComF. During follow-up, 28 patients died before ventricular assist device implantation or HT. Frailty was associated with significantly lower ventricular assist device- and HT-free survival, with CogF best capturing early mortality: 12-month survival for non-frail and frail cohorts was 81% ± 5% vs 58% ± 10% (p < 0.02) using PF and 85% ± 5% vs 56% ± 9% (p < 0.002) using CogF. Combining the Depression in Medical Illness score with PF or CogF did not strengthen the relationship between frailty and mortality. Conclusions The addition of cognitive impairment to the assessment of PF strengthened its capacity to identify advanced heart failure patients referred for HT who are at high risk of early death.

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http://hdl.handle.net/10453/92762