title: The Prevalence and Prognostic Significance of Frailty in Patients With Advanced Heart Failure Referred for Heart Transplantation.
abstract: BACKGROUND
  Frailty is a clinically recognized syndrome of decreased physiological reserve. The heightened state of vulnerability in these patients confers a greater risk of adverse outcomes after even minor stressors. Our aim was to assess the prevalence and prognostic significance of the frailty phenotype in patients referred for heart transplantation.
  
  
  METHODS
  Consecutive patients referred or on the waiting list for heart transplantation from March 2013 underwent frailty assessment. Frailty was defined as a positive response to 3 or more of the following 5 components: weak grip strength, slowed walking speed, poor appetite, physical inactivity, and exhaustion. In addition, markers of disease severity were obtained, and all patients underwent cognitive (Montreal Cognitive Assessment) and depression (Depression in Medical Illness-10) screening.
  
  
  RESULTS
  One hundred twenty patients (83 men:37 women; age, 53 ± 12 years, range, 16-73 years; left ventricular ejection fraction, 27 ± 14%) underwent frailty assessment. Thirty-nine of 120 patients (33%) were assessed as frail. Frailty was associated with New York Heart Association class IV heart failure, lower body mass index, elevated intracardiac filling pressures, lower cardiac index, anemia, hypoalbuminemia, hyperbilirubinemia, cognitive impairment, and depression (all ρ < 0.05). Frailty was independent of age, sex, heart failure duration, left ventricular ejection fraction, or renal function. Frailty was an independent predictor of increased all-cause mortality: 1 year actuarial survival was 79 ± 5% in the nonfrail group compared with only 54 ± 9% for the frail group (P < 0.005).
  
  
  CONCLUSIONS
  Frailty is prevalent among patients with advanced symptomatic heart failure referred for heart transplantation and is associated with increased mortality.
authors.affiliation: 1 Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia. 2 Centre for Cardiovascular and Chronic Care, Faculty Health, University of Technology Sydney, Sydney, Australia. 3 Department of Occupational Therapy, St Vincent's Hospital, Sydney, NSW, Australia. 4 Consultation Liaison Psychiatry, St Vincent's Hospital, Sydney, NSW, Australia. 5 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. 6 Victor Chang Cardiac Research Institute, Sydney, NSW, Australia. 7 Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, NSW, Australia. 8 Faculty of Nursing, John Hopkins University, Baltimore, MD.
authors.forename: Sunita R
authors.initials: SR
authors.lastname: Jha
authors.forename: Malin K
authors.initials: MK
authors.lastname: Hannu
authors.forename: Sungwon
authors.initials: S
authors.lastname: Chang
authors.forename: Elyn
authors.initials: E
authors.lastname: Montgomery
authors.forename: Michelle
authors.initials: M
authors.lastname: Harkess
authors.forename: Kay
authors.initials: K
authors.lastname: Wilhelm
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hayward
authors.forename: Andrew
authors.initials: A
authors.lastname: Jabbour
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Spratt
authors.forename: Phillip
authors.initials: P
authors.lastname: Newton
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.forename: Peter S
authors.initials: PS
authors.lastname: Macdonald
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D016330:Frail Elderly; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010641:Phenotype; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult