Clinician Assessed Versus Objective Measures of Frailty in Left Ventricular Assist Device Patients

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Heart Lung Transplant

Abstract

Purpose: Society guidelines recommend frailty assessment in Left Ventricular Assist Device (LVAD) candidates. Frailty is a multi-domain syndrome that includes compromised mobility and nutritional status. While often assessed via the “eyeball test,” there is a need to identify objective frailty measures that correlate with patient outcomes, allowing for standardization of candidacy assessment. We studied 1) the association of clinician assessed frailty with objective measures of mobility (6-minute walk distance, 6MWD) and nutritional status (prealbumin), and 2) the association of these factors with outcomes. Methods: We included LVAD patients from 2007-17 from the Intermacs registry who had frailty status reported. Objective frailty measures were compared between patients with and without clinician assessed frailty. Multivariable models were used to study the association between objective frailty measures and post-LVAD mortality. The association of clinician assessed frailty with mortality was studied via a propensity score-matched analysis, matching for disease severity and objective frailty measures. Results: Of 15,371 patients (age: 56.9 13.0 yrs, 21% female, 24% Black), 1015 (6.6%) were clinician assessed as frail. Clinician assessed frailty correlated with objective frailty measures. (Table 1) Patients too sick to complete testing or those with 6MWD <300 m, and prealbumin<16 mg/dL had significantly worse mortality than those with values above these thresholds, independent of clinician assessed frailty. (Table 2) Clinician assessed frailty remained associated with mortality in the propensity-matched analysis (n=932, HR: 1.25 [1.01-1.55], p=0.04). Conclusion: In this analysis, we demonstrate that routinely obtained, objective measures of frailty can be used to identify patients at risk for increased events after LVAD. Utilization of objective measures may allow for improved frailty comparisons over time, between centers, and amongst different patient populations. [Formula presented]

Volume

43

Issue

4

First Page

S500

Last Page

S501

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