5 years ago

Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?

Sean Pinney, Melana Yuzefpolskaya, Nathan E. Goldstein, Gordon R. Reeves, Deena Goldwater, Alex Reyentovich, Mathew S. Maurer, Sergio Teruya, Jeff Goldsmith, Omar Jimenez, Victoria Vaughan Dickson, Stephen Helmke, Evelyn Horn
Background/Objectives Frailty, characterized by low physiological reserves, is strongly associated with vulnerability to adverse outcomes. Features of frailty overlap with those of advanced heart failure, making a distinction between them difficult. We sought to determine whether implantation of a left ventricular assist device (LVAD) would decrease frailty. Design Prospective, cohort study. Setting Five academic medical centers. Participants Frail individuals (N = 29; mean age 70.6 ± 5.5, 72.4% male). Measurements Frailty, defined as having 3 or more of the Fried frailty criteria, was assessed before LVAD implantation and 1, 3, and 6 months after implantation. Other domains assessed included quality of life, using the Kansas City Cardiomyopathy Questionnaire; mood, using the Patient Health Questionnaire; and cognitive function, using the Trail-Making Test Part B. Results After 6 months, three subjects had died, and one had undergone a heart transplant; of 19 subjects with serial frailty measures, the average number of frailty criteria decreased from 3.9 ± 0.9 at baseline to 2.8 ± 1.4 at 6 months (P = .003). Improvements were observed after 3 to 6 months of LVAD support, although 10 (52.6%) participants still had 3 or more Fried criteria, and all subjects had at least one at 6 months. Changes in frailty were associated with improvement in QOL but not with changes in mood or cognition. Higher estimated glomerular filtration rate at baseline was independently associated with a decrease in frailty. Conclusion Frailty decreased in approximately half of older adults with advanced heart failure after 6 months of LVAD support. Strategies to enhance frailty reversal in this population are worthy of additional study.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/jgs.15124

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