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Assessing Frailty in Patients Undergoing Destination Therapy Left Ventricular Assist Device: Observations from Interagency Registry for Mechanically Assisted Circulatory Support

Cooper, Lauren B.*†; Hammill, Bradley G.; Allen, Larry A.§¶; Lindenfeld, JoAnn; Mentz, Robert J.†‡; Rogers, Joseph G.†‡; Milano, Carmelo A.‡#; Patel, Chetan B.†‡; Alexander, Karen P.†‡; Hernandez, Adrian F.†‡

doi: 10.1097/MAT.0000000000000600
Adult Circulatory Support

Frailty and heart failure share common pathways with symptoms that often coexist. Assessment of frailty may inform patient selection for left ventricular assist device (LVAD) therapy. Using Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) data of destination therapy (DT) LVAD patients from January 1, 2012, to March 31, 2014, we examined preimplantation provider-assessed frailty and gait speed testing and the association with 1 year postimplantation outcomes. Of 2,469 patients, 227 (9.2%) had provider-assessed frailty. Only 320 (13.0%) completed gait speed testing, whereas 1,047 (42.4%) were “too sick” to perform the test. Provider-assessed frail and nonfrail patients had similar distributions of INTERMACS profiles and similar median gait speeds. One year mortality was higher for patients with provider-assessed frailty versus nonfrail (24.6% vs. 18.9%; p = 0.01) and for those too sick to complete gait speed testing versus completed testing (22.0% vs. 15.9%). There was an association between provider-assessed frailty and mortality, although it was not clinically significant after adjustment (hazard ratio [HR]: 1.38 [95% confidence interval {CI}: 0.97–1.95]). Useful information regarding frailty on postimplant mortality is gained from provider assessment of frailty or knowing gait speed could not be performed. Development of frailty measures better suited for DT LVAD candidates may help in distinguishing between a frailty phenotype and a more reversible from heart failure–related vulnerability.

From the *Inova Heart and Vascular Institute, Falls Church, Virginia; Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; §Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado; Department of Medicine, Division of Cardiovascular Medicine and Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee; and #Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.

Submitted for consideration October 2016; accepted for publication in revised form April 2017.

This project has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), under Contract number HHSN268201100025C.

The data for this study came from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), NHLBI, Contract number HHSN268200548198C, 2010. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH).

Disclosures: Dr. Cooper was supported by grant T32HL069749-11A1 from the NIH. Dr. Allen’s time and the analytics for this study were supported by K23HL105896 from NHLBI of the NIH. He receives grant funding from NIH and PCORI, and consultancy fees from Novartis, Janssen, and St. Jude. Dr. Mentz received grant funding from Amgen, AstraZeneca, Bristol-Myers Squibb, Glaxo SmithKline, Novartis, Otsuka, Thoratec, and ResMed, and consultancy fees from Luitpold. Dr. Alexander received research support from Gilead, Sanofi-Aventis, and Regeneron, and consultancy fees from CytRx. Dr. Hernandez received research support from the American Heart Association, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Merck, and Portola; and serving as a consultant or scientific advisor to Amgen, AstraZeneca, Bayer, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Merck, MyoKardia, Novartis, Ortho McNeil-Janssen, Pfizer, Pluristem, and Sensible. No other disclosures were reported.

Correspondence: Lauren Cooper, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA, 22042. Email:

Copyright © 2018 by the American Society for Artificial Internal Organs