TY - JOUR
T1 - Frailty Measures of Patient-reported Activity and Fatigue May Predict 1-year Outcomes in Ambulatory Advanced Heart Failure
T2 - A Report From the REVIVAL Registry
AU - LALA, ANURADHA
AU - SHAH, PALAK
AU - KHALATBARI, SHOKOUFEH
AU - YOSEF, MATHEOS
AU - MOUNTIS, MARIA M.
AU - ROBINSON, SHAWN W.
AU - LANFEAR, DAVID E.
AU - ESTEP, JERRY D.
AU - JEFFRIES, N. E.A.L.
AU - TADDEI-PETERS, WENDY C.
AU - STEVENSON, LYNNE W.
AU - RICHARDS, BLAIR
AU - MANN, DOUGLAS L.
AU - MANCINI, DONNA M.
AU - STEWART, GARRICK C.
AU - AARONSON, KEITH D.
N1 - Publisher Copyright:
© 2021
PY - 2022/5
Y1 - 2022/5
N2 - Background: The Fried Frailty Phenotype predicts adverse outcomes in geriatric populations, but has not been well-studied in advanced heart failure (HF). The Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study prospectively collected frailty measures in patients with advanced HF to determine relevant assessments and their impact on clinical outcomes. Methods and Results: HF-Fried Frailty was defined by 5 baseline components (1 point each): (1) weakness: hand grip strength less than 25% of body weight; (2) slowness based on time to walk 15 feet; (3) weight loss of more than 10 lbs in the past year; (4) inactivity; and (5) exhaustion, both assessed by the Kansas City Cardiomyopathy Questionnaire. A score of 0 or 1 was deemed nonfrail, 2 prefrail, and 3 or greater was considered frail. The primary composite outcome was durable mechanical circulatory support implantation, cardiac transplant or death at 1 year. Event-free survival for each group was determined by the Kaplan–Meier method and the hazard of prefrailty and frailty were compared with nonfrailty with proportional hazards modeling. Among 345 patients with all 5 frailty domains assessed, frailty was present in 17%, prefrailty in 40%, and 43% were nonfrail, with 67% (n = 232) meeting the criteria based on inactivity and 54% (n = 186) for exhaustion. Frail patients had an increased risk of the primary composite outcome (unadjusted hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.52–5.24; adjusted HR 3.41, 95% CI 1.79–6.52), as did prefrail patients (unadjusted HR 1.97, 95% CI 1.14–3.41; adjusted HR 2.11, 95% CI 1.21–3.66) compared with nonfrail patients, however, the predictive value of HF-Fried Frailty criteria was modest (Harrel's C-statistic of 0.603, P = .004). Conclusions: The HF-Fried Frailty criteria had only modest predictive power in identifying ambulatory patients with advanced HF at high risk for durable mechanical circulatory support, transplant, or death within 1 year, driven primarily by assessments of inactivity and exhaustion. Focus on these patient-reported measures may better inform clinical trajectories in this population.
AB - Background: The Fried Frailty Phenotype predicts adverse outcomes in geriatric populations, but has not been well-studied in advanced heart failure (HF). The Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study prospectively collected frailty measures in patients with advanced HF to determine relevant assessments and their impact on clinical outcomes. Methods and Results: HF-Fried Frailty was defined by 5 baseline components (1 point each): (1) weakness: hand grip strength less than 25% of body weight; (2) slowness based on time to walk 15 feet; (3) weight loss of more than 10 lbs in the past year; (4) inactivity; and (5) exhaustion, both assessed by the Kansas City Cardiomyopathy Questionnaire. A score of 0 or 1 was deemed nonfrail, 2 prefrail, and 3 or greater was considered frail. The primary composite outcome was durable mechanical circulatory support implantation, cardiac transplant or death at 1 year. Event-free survival for each group was determined by the Kaplan–Meier method and the hazard of prefrailty and frailty were compared with nonfrailty with proportional hazards modeling. Among 345 patients with all 5 frailty domains assessed, frailty was present in 17%, prefrailty in 40%, and 43% were nonfrail, with 67% (n = 232) meeting the criteria based on inactivity and 54% (n = 186) for exhaustion. Frail patients had an increased risk of the primary composite outcome (unadjusted hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.52–5.24; adjusted HR 3.41, 95% CI 1.79–6.52), as did prefrail patients (unadjusted HR 1.97, 95% CI 1.14–3.41; adjusted HR 2.11, 95% CI 1.21–3.66) compared with nonfrail patients, however, the predictive value of HF-Fried Frailty criteria was modest (Harrel's C-statistic of 0.603, P = .004). Conclusions: The HF-Fried Frailty criteria had only modest predictive power in identifying ambulatory patients with advanced HF at high risk for durable mechanical circulatory support, transplant, or death within 1 year, driven primarily by assessments of inactivity and exhaustion. Focus on these patient-reported measures may better inform clinical trajectories in this population.
KW - Heart failure
KW - frailty
KW - heart transplant
KW - left ventricular assist device
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85121830622&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2021.10.014
DO - 10.1016/j.cardfail.2021.10.014
M3 - Article
C2 - 34961663
AN - SCOPUS:85121830622
SN - 1071-9164
VL - 28
SP - 765
EP - 774
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 5
ER -