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

Autor: Phillip Spratt, Christopher S. Hayward, Peter S. Macdonald, M. Harkess, Andrew Jabbour, M. Hannu, E. Montgomery, Phillip J. Newton, Sungwon Chang, Kay Wilhelm, Sunita R Jha, Patricia M. Davidson
Rok vydání: 2016
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Adolescent
Waiting Lists
Frail Elderly
Health Status
medicine.medical_treatment
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Risk Assessment
Severity of Illness Index
Young Adult
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Severity of illness
Prevalence
medicine
Humans
030212 general & internal medicine
Hypoalbuminemia
Referral and Consultation
Depression (differential diagnoses)
Aged
Proportional Hazards Models
Heart Failure
Heart transplantation
Transplantation
Ejection fraction
business.industry
Proportional hazards model
Patient Selection
Age Factors
Montreal Cognitive Assessment
Middle Aged
Prognosis
medicine.disease
Phenotype
Heart failure
Physical therapy
Cardiology
Heart Transplantation
Female
business
Zdroj: Transplantation. 100:429-436
ISSN: 0041-1337
DOI: 10.1097/tp.0000000000000991
Popis: 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.
Databáze: OpenAIRE
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