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J Am Geriatr Soc. 2017 Nov;65(11):2383-2390. doi: 10.1111/jgs.15124. Epub 2017 Sep 21.

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

Author information

1
Clinical Cardiovascular Research Laboratory for the Elderly, Columbia University Medical Center, Allen Hospital of New York Presbyterian, New York, New York.
2
Weill Medical College of Cornell University, New York, New York.
3
New York University Langone Medical Center, New York, New York.
4
New York University, Meyers College of Nursing, New York, New York.
5
Icahn School of Medicine at Mount Sinai, New York, New York.
6
Cedars-Sinai Medical Center, Los Angeles, California.
7
Department of Geriatrics, Mount Sinai School of Medicine, New York, New York.
8
Medicine, Columbia University, New York, New York.
9
Biostatistics, Columbia University, New York, New York.
10
Thomas Jefferson University, Philadelphia, Pennsylvania.

Abstract

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.

KEYWORDS:

advanced heart failure; frailty; ventricular assist device

PMID:
28940248
PMCID:
PMC5681378
DOI:
10.1111/jgs.15124
[Indexed for MEDLINE]
Free PMC Article

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