TY - JOUR
T1 - Frailty Measures of Patient-reported Activity and Fatigue May Predict 1-year Outcomes in Ambulatory Advanced Heart Failure
T2 - A Report From the REVIVAL Registry
AU - LALA, ANURADHA
AU - SHAH, PALAK
AU - KHALATBARI, SHOKOUFEH
AU - YOSEF, MATHEOS
AU - MOUNTIS, MARIA M.
AU - ROBINSON, SHAWN W.
AU - LANFEAR, DAVID E.
AU - ESTEP, JERRY D.
AU - JEFFRIES, N. E.A.L.
AU - TADDEI-PETERS, WENDY C.
AU - STEVENSON, LYNNE W.
AU - RICHARDS, BLAIR
AU - MANN, DOUGLAS L.
AU - MANCINI, DONNA M.
AU - STEWART, GARRICK C.
AU - AARONSON, KEITH D.
N1 - Funding Information:
A.L. reports speaker honoraria from Zoll medical and is a consultant for Bioventrix and Susquana. P.S. reports grant support from, Bayer, Abbott, Roche, and Merck; consulting for Novartis, Roche, Procyrion, and Ortho Clinical Diagnostics. D.E.L.’s effort is supported in part by the NHLBI (R01HL132154) and he reports research grants from Amgen, Bayer, Astra-Zeneca, Lilly, Critical Diagnostics, Somalogic, and Janssen; he has acted as consultant for Amgen, Abbot, Janssen, Ortho Clinical Diagnostics, Cytokinetics, Martin Pharmaceuticals, and Novartis.
Funding Information:
Supported by funding from the National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI Contract Number:HHSN268201100026C) and the National Center for Advancing Translational Sciences (NCATS Grant Number: UL1TR002240) for the Michigan Institute for Clinical and Health Research. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services. P.S. is supported by NIH K23 Career Development Award 1K23HL143179.
Publisher Copyright:
© 2021
PY - 2022/5
Y1 - 2022/5
N2 - Background: The Fried Frailty Phenotype predicts adverse outcomes in geriatric populations, but has not been well-studied in advanced heart failure (HF). The Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study prospectively collected frailty measures in patients with advanced HF to determine relevant assessments and their impact on clinical outcomes. Methods and Results: HF-Fried Frailty was defined by 5 baseline components (1 point each): (1) weakness: hand grip strength less than 25% of body weight; (2) slowness based on time to walk 15 feet; (3) weight loss of more than 10 lbs in the past year; (4) inactivity; and (5) exhaustion, both assessed by the Kansas City Cardiomyopathy Questionnaire. A score of 0 or 1 was deemed nonfrail, 2 prefrail, and 3 or greater was considered frail. The primary composite outcome was durable mechanical circulatory support implantation, cardiac transplant or death at 1 year. Event-free survival for each group was determined by the Kaplan–Meier method and the hazard of prefrailty and frailty were compared with nonfrailty with proportional hazards modeling. Among 345 patients with all 5 frailty domains assessed, frailty was present in 17%, prefrailty in 40%, and 43% were nonfrail, with 67% (n = 232) meeting the criteria based on inactivity and 54% (n = 186) for exhaustion. Frail patients had an increased risk of the primary composite outcome (unadjusted hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.52–5.24; adjusted HR 3.41, 95% CI 1.79–6.52), as did prefrail patients (unadjusted HR 1.97, 95% CI 1.14–3.41; adjusted HR 2.11, 95% CI 1.21–3.66) compared with nonfrail patients, however, the predictive value of HF-Fried Frailty criteria was modest (Harrel's C-statistic of 0.603, P = .004). Conclusions: The HF-Fried Frailty criteria had only modest predictive power in identifying ambulatory patients with advanced HF at high risk for durable mechanical circulatory support, transplant, or death within 1 year, driven primarily by assessments of inactivity and exhaustion. Focus on these patient-reported measures may better inform clinical trajectories in this population.
AB - Background: The Fried Frailty Phenotype predicts adverse outcomes in geriatric populations, but has not been well-studied in advanced heart failure (HF). The Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study prospectively collected frailty measures in patients with advanced HF to determine relevant assessments and their impact on clinical outcomes. Methods and Results: HF-Fried Frailty was defined by 5 baseline components (1 point each): (1) weakness: hand grip strength less than 25% of body weight; (2) slowness based on time to walk 15 feet; (3) weight loss of more than 10 lbs in the past year; (4) inactivity; and (5) exhaustion, both assessed by the Kansas City Cardiomyopathy Questionnaire. A score of 0 or 1 was deemed nonfrail, 2 prefrail, and 3 or greater was considered frail. The primary composite outcome was durable mechanical circulatory support implantation, cardiac transplant or death at 1 year. Event-free survival for each group was determined by the Kaplan–Meier method and the hazard of prefrailty and frailty were compared with nonfrailty with proportional hazards modeling. Among 345 patients with all 5 frailty domains assessed, frailty was present in 17%, prefrailty in 40%, and 43% were nonfrail, with 67% (n = 232) meeting the criteria based on inactivity and 54% (n = 186) for exhaustion. Frail patients had an increased risk of the primary composite outcome (unadjusted hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.52–5.24; adjusted HR 3.41, 95% CI 1.79–6.52), as did prefrail patients (unadjusted HR 1.97, 95% CI 1.14–3.41; adjusted HR 2.11, 95% CI 1.21–3.66) compared with nonfrail patients, however, the predictive value of HF-Fried Frailty criteria was modest (Harrel's C-statistic of 0.603, P = .004). Conclusions: The HF-Fried Frailty criteria had only modest predictive power in identifying ambulatory patients with advanced HF at high risk for durable mechanical circulatory support, transplant, or death within 1 year, driven primarily by assessments of inactivity and exhaustion. Focus on these patient-reported measures may better inform clinical trajectories in this population.
KW - Heart failure
KW - frailty
KW - heart transplant
KW - left ventricular assist device
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85121830622&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2021.10.014
DO - 10.1016/j.cardfail.2021.10.014
M3 - Article
C2 - 34961663
AN - SCOPUS:85121830622
SN - 1071-9164
VL - 28
SP - 765
EP - 774
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 5
ER -