Frailty and outcomes after implantation of left ventricular assist device as destination therapy

Shannon M Dunlay, Soon J. Park, Lyle D. Joyce, Richard C. Daly, John M. Stulak, Sheila M. McNallan, Veronique Lee Roger, Sudhir S. Kushwaha

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background Frailty is recognized as a major prognostic indicator in heart failure. There has been interest in understanding whether pre-operative frailty is associated with worse outcomes after implantation of a left ventricular assist device (LVAD) as destination therapy. Methods Patients undergoing LVAD implantation as destination therapy at the Mayo Clinic, Rochester, Minnesota, from February 2007 to June 2012, were included in this study. Frailty was assessed using the deficit index (31 impairments, disabilities and comorbidities) and defined as the proportion of deficits present. We divided patients based on tertiles of the deficit index (>0.32 = frail, 0.23 to 0.32 = intermediate frail, <0.23 = not frail). Cox proportional hazard regression models were used to examine the association between frailty and death. Patients were censored at death or last follow-up through October 2013. Results Among 99 patients (mean age 65 years, 18% female, 55% with ischemic heart failure), the deficit index ranged from 0.10 to 0.65 (mean 0.29). After a mean follow-up of 1.9 ± 1.6 years, 79% of the patients had been rehospitalized (range 0 to 17 hospitalizations, median 1 per person) and 45% had died. Compared with those who were not frail, patients who were intermediate frail (adjusted HR 1.70, 95% CI 0.71 to 4.31) and frail (HR 3.08, 95% CI 1.40 to 7.48) were at increased risk for death (p for trend = 0.004). The mean (SD) number of days alive out of hospital the first year after LVAD was 293 (107) for not frail, 266 (134) for intermediate frail and 250 (132) for frail patients. Conclusions Frailty before destination LVAD implantation is associated with increased risk of death and may represent a significant patient selection consideration.

Original languageEnglish (US)
Pages (from-to)359-365
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number4
DOIs
StatePublished - 2014

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Heart-Assist Devices
Therapeutics
Heart Failure
Proportional Hazards Models
Patient Selection
Comorbidity
Hospitalization

Keywords

  • destination
  • frailty
  • heart failure
  • left ventricular assist device
  • mortality
  • readmission

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery
  • Medicine(all)

Cite this

Frailty and outcomes after implantation of left ventricular assist device as destination therapy. / Dunlay, Shannon M; Park, Soon J.; Joyce, Lyle D.; Daly, Richard C.; Stulak, John M.; McNallan, Sheila M.; Roger, Veronique Lee; Kushwaha, Sudhir S.

In: Journal of Heart and Lung Transplantation, Vol. 33, No. 4, 2014, p. 359-365.

Research output: Contribution to journalArticle

Dunlay, Shannon M ; Park, Soon J. ; Joyce, Lyle D. ; Daly, Richard C. ; Stulak, John M. ; McNallan, Sheila M. ; Roger, Veronique Lee ; Kushwaha, Sudhir S. / Frailty and outcomes after implantation of left ventricular assist device as destination therapy. In: Journal of Heart and Lung Transplantation. 2014 ; Vol. 33, No. 4. pp. 359-365.
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AU - Dunlay, Shannon M

AU - Park, Soon J.

AU - Joyce, Lyle D.

AU - Daly, Richard C.

AU - Stulak, John M.

AU - McNallan, Sheila M.

AU - Roger, Veronique Lee

AU - Kushwaha, Sudhir S.

PY - 2014

Y1 - 2014

N2 - Background Frailty is recognized as a major prognostic indicator in heart failure. There has been interest in understanding whether pre-operative frailty is associated with worse outcomes after implantation of a left ventricular assist device (LVAD) as destination therapy. Methods Patients undergoing LVAD implantation as destination therapy at the Mayo Clinic, Rochester, Minnesota, from February 2007 to June 2012, were included in this study. Frailty was assessed using the deficit index (31 impairments, disabilities and comorbidities) and defined as the proportion of deficits present. We divided patients based on tertiles of the deficit index (>0.32 = frail, 0.23 to 0.32 = intermediate frail, <0.23 = not frail). Cox proportional hazard regression models were used to examine the association between frailty and death. Patients were censored at death or last follow-up through October 2013. Results Among 99 patients (mean age 65 years, 18% female, 55% with ischemic heart failure), the deficit index ranged from 0.10 to 0.65 (mean 0.29). After a mean follow-up of 1.9 ± 1.6 years, 79% of the patients had been rehospitalized (range 0 to 17 hospitalizations, median 1 per person) and 45% had died. Compared with those who were not frail, patients who were intermediate frail (adjusted HR 1.70, 95% CI 0.71 to 4.31) and frail (HR 3.08, 95% CI 1.40 to 7.48) were at increased risk for death (p for trend = 0.004). The mean (SD) number of days alive out of hospital the first year after LVAD was 293 (107) for not frail, 266 (134) for intermediate frail and 250 (132) for frail patients. Conclusions Frailty before destination LVAD implantation is associated with increased risk of death and may represent a significant patient selection consideration.

AB - Background Frailty is recognized as a major prognostic indicator in heart failure. There has been interest in understanding whether pre-operative frailty is associated with worse outcomes after implantation of a left ventricular assist device (LVAD) as destination therapy. Methods Patients undergoing LVAD implantation as destination therapy at the Mayo Clinic, Rochester, Minnesota, from February 2007 to June 2012, were included in this study. Frailty was assessed using the deficit index (31 impairments, disabilities and comorbidities) and defined as the proportion of deficits present. We divided patients based on tertiles of the deficit index (>0.32 = frail, 0.23 to 0.32 = intermediate frail, <0.23 = not frail). Cox proportional hazard regression models were used to examine the association between frailty and death. Patients were censored at death or last follow-up through October 2013. Results Among 99 patients (mean age 65 years, 18% female, 55% with ischemic heart failure), the deficit index ranged from 0.10 to 0.65 (mean 0.29). After a mean follow-up of 1.9 ± 1.6 years, 79% of the patients had been rehospitalized (range 0 to 17 hospitalizations, median 1 per person) and 45% had died. Compared with those who were not frail, patients who were intermediate frail (adjusted HR 1.70, 95% CI 0.71 to 4.31) and frail (HR 3.08, 95% CI 1.40 to 7.48) were at increased risk for death (p for trend = 0.004). The mean (SD) number of days alive out of hospital the first year after LVAD was 293 (107) for not frail, 266 (134) for intermediate frail and 250 (132) for frail patients. Conclusions Frailty before destination LVAD implantation is associated with increased risk of death and may represent a significant patient selection consideration.

KW - destination

KW - frailty

KW - heart failure

KW - left ventricular assist device

KW - mortality

KW - readmission

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