title: Handle with care: A systematic review on frailty in cardiac care and its usefulness in heart transplantation.
abstract: There is growing consensus that frailty, a state of vulnerability and a decline in functioning across multiple physiological body systems, is a valuable criterion to guide clinicians' risk prediction for poor outcomes in adult transplant candidates. In its 2016 listing criteria for heart transplantation the International Society for Heart Lung Transplantation recommends frailty assessment. We aimed to summarize the usefulness of frailty assessment in heart transplant candidates or recipients reported throughout the literature.
  
  
  
  We performed a systematic literature search in PubMed to identify papers reporting on frailty in transplantation, chronic heart failure, and ventricualr assist device implantation published over the last 10 years in English. Additionally, a hand search was conducted, including manually searching the reference lists and a citation search of relevant papers.
  
  
  
  Eleven primary research articles were included in this systematic review. Frailty is a risk factor for morbidity, hospitalization, and mortality in patients with advanced heart failure and individuals being considered for ventricualr assist device implantation. Of the patients being considered for transplantation, 33% are frail. The Frailty Phenotype by Fried is a particularly useful tool to quickly identify higher risk patients for adverse outcomes.
  
  
  
  A lack of standardization and limited evidence on frailty in transplantation limit its use as a definitive listing criterion. Future research efforts should focus on systematic integration of frailty measures in transplant practice.
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland. Electronic address: oliver.mauthner@unibas.ch.
authors.forename: Oliver
authors.initials: O
authors.lastname: Mauthner
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.
authors.forename: Veerle
authors.initials: V
authors.lastname: Claes
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.
authors.forename: Mieke
authors.initials: M
authors.lastname: Deschodt
authors.affiliation: Heart Transplant Program, St Vincent's Hospital, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty Health, University of Technology Sydney.
authors.forename: Sunita R
authors.initials: SR
authors.lastname: Jha
authors.affiliation: School of Nursing, University of Pittsburgh, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Engberg
authors.affiliation: Heart Transplant Program, St Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Macdonald
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty Health, University of Technology Sydney.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
mesh_terms: D000073496:Frailty; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans