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

Mathew S. Maurer, Evelyn Horn, Alex Reyentovich, Victoria Vaughan Dickson, Sean Pinney, Deena Goldwater, Nathan E. Goldstein, Omar Jimenez, Sergio Teruya, Jeff Goldsmith, Stephen Helmke, Melana Yuzefpolskaya, Gordon R. Reeves

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - 2017

Fingerprint

Systolic Heart Failure
Heart-Assist Devices
Cognition
Heart Failure
Trail Making Test
Glomerular Filtration Rate
Cardiomyopathies
Cohort Studies
Quality of Life
Prospective Studies
Transplants
Health
Population
Surveys and Questionnaires

Keywords

  • Advanced heart failure
  • Frailty
  • Ventricular assist device

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty? / Maurer, Mathew S.; Horn, Evelyn; Reyentovich, Alex; Vaughan Dickson, Victoria; Pinney, Sean; Goldwater, Deena; Goldstein, Nathan E.; Jimenez, Omar; Teruya, Sergio; Goldsmith, Jeff; Helmke, Stephen; Yuzefpolskaya, Melana; Reeves, Gordon R.

In: Journal of the American Geriatrics Society, 2017.

Research output: Contribution to journalArticle

Maurer, MS, Horn, E, Reyentovich, A, Vaughan Dickson, V, Pinney, S, Goldwater, D, Goldstein, NE, Jimenez, O, Teruya, S, Goldsmith, J, Helmke, S, Yuzefpolskaya, M & Reeves, GR 2017, 'Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?', Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.15124
Maurer, Mathew S. ; Horn, Evelyn ; Reyentovich, Alex ; Vaughan Dickson, Victoria ; Pinney, Sean ; Goldwater, Deena ; Goldstein, Nathan E. ; Jimenez, Omar ; Teruya, Sergio ; Goldsmith, Jeff ; Helmke, Stephen ; Yuzefpolskaya, Melana ; Reeves, Gordon R. / Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?. In: Journal of the American Geriatrics Society. 2017.
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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.",
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AU - Maurer, Mathew S.

AU - Horn, Evelyn

AU - Reyentovich, Alex

AU - Vaughan Dickson, Victoria

AU - Pinney, Sean

AU - Goldwater, Deena

AU - Goldstein, Nathan E.

AU - Jimenez, Omar

AU - Teruya, Sergio

AU - Goldsmith, Jeff

AU - Helmke, Stephen

AU - Yuzefpolskaya, Melana

AU - Reeves, Gordon R.

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - Advanced heart failure

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KW - Ventricular assist device

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