Frailty and outcomes after implantation of left ventricular assist device as destination therapy.
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.
Division of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota; Department of Health Sciences Research, Rochester, Minnesota. Electronic address: dunlay.shannon@mayo.edu.
Shannon M
SM
Dunlay
Division of Cardiac Surgery, University Hospitals in Cleveland Ohio.
Soon J
SJ
Park
Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Lyle D
LD
Joyce
Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Richard C
RC
Daly
Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
John M
JM
Stulak
Department of Health Sciences Research, Rochester, Minnesota.
Sheila M
SM
McNallan
Division of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota; Department of Health Sciences Research, Rochester, Minnesota.
Véronique L
VL
Roger
Division of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota.
Sudhir S
SS
Kushwaha
D000046:Academic Medical Centers; D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016019:Survival Analysis
destination; frailty; heart failure; left ventricular assist device; mortality; readmission