Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy
Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable meas...
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| Veröffentlicht in: | The American journal of cardiology 2017-10, Vol.120 (8), p.1349-1354 |
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| creator | Joseph, Susan M. Manghelli, Joshua L. Vader, Justin M. Keeney, Tamra Novak, Eric L. Felius, Joost Martinez, Sara C. Nassif, Michael E. Lima, Brian Silvestry, Scott C. Rich, Michael W. |
| description | Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population. |
| doi_str_mv | 10.1016/j.amjcard.2017.07.074 |
| format | Article |
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Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2017.07.074</identifier><identifier>PMID: 28843393</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adults ; Age ; Aged ; Aged, 80 and over ; Cardiovascular disease ; Confidence intervals ; Criteria ; Exhaustion ; Extubation ; Female ; Frail Elderly - statistics & numerical data ; Frailty ; Geriatric Assessment - methods ; Grip strength ; Heart ; Heart diseases ; Heart failure ; Heart Failure - mortality ; Heart Failure - therapy ; Heart surgery ; Heart-Assist Devices ; Hospitals ; Humans ; Implantation ; Inpatients ; Liver diseases ; Male ; Middle Aged ; Mortality ; Odds Ratio ; Older people ; Patients ; Prospective Studies ; Risk Assessment - methods ; Risk Factors ; Surgery ; Survival Rate - trends ; Therapy ; Transplants & implants ; United States - epidemiology ; Ventilators ; Ventricle ; Ventricular assist devices</subject><ispartof>The American journal of cardiology, 2017-10, Vol.120 (8), p.1349-1354</ispartof><rights>2017</rights><rights>Copyright © 2017. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Sequoia S.A. Oct 15, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-1e9e90c65a614e06acab3a5dc8922803220b7f4809f7a38d3ecd8f10573287283</citedby><cites>FETCH-LOGICAL-c393t-1e9e90c65a614e06acab3a5dc8922803220b7f4809f7a38d3ecd8f10573287283</cites><orcidid>0000-0001-7200-8755</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S000291491731247X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28843393$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Joseph, Susan M.</creatorcontrib><creatorcontrib>Manghelli, Joshua L.</creatorcontrib><creatorcontrib>Vader, Justin M.</creatorcontrib><creatorcontrib>Keeney, Tamra</creatorcontrib><creatorcontrib>Novak, Eric L.</creatorcontrib><creatorcontrib>Felius, Joost</creatorcontrib><creatorcontrib>Martinez, Sara C.</creatorcontrib><creatorcontrib>Nassif, Michael E.</creatorcontrib><creatorcontrib>Lima, Brian</creatorcontrib><creatorcontrib>Silvestry, Scott C.</creatorcontrib><creatorcontrib>Rich, Michael W.</creatorcontrib><title>Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population.</description><subject>Adults</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiovascular disease</subject><subject>Confidence intervals</subject><subject>Criteria</subject><subject>Exhaustion</subject><subject>Extubation</subject><subject>Female</subject><subject>Frail Elderly - statistics & numerical data</subject><subject>Frailty</subject><subject>Geriatric Assessment - methods</subject><subject>Grip strength</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - therapy</subject><subject>Heart surgery</subject><subject>Heart-Assist Devices</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Implantation</subject><subject>Inpatients</subject><subject>Liver diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Odds Ratio</subject><subject>Older people</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Survival Rate - trends</subject><subject>Therapy</subject><subject>Transplants & implants</subject><subject>United States - epidemiology</subject><subject>Ventilators</subject><subject>Ventricle</subject><subject>Ventricular assist devices</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUtrGzEUhUVoSRy3PyFF0E034-oxD2kVgvMEQ7OIuxWydCfRMA9X0pj431eDnSyyCVwkdPnu0eUchC4oWVBCy9_NQneN0d4uGKHVgkyVn6AZFZXMqKT8C5oRQlgmaS7P0HkITXpSWpSn6IwJkXMu-Qy9PvohbMFEtwN8FQKE0EEf8VDjW69dG_d4HVz_jOMLpI4Di5feRfBOY9fjRx1dwgNe9xb88zCRK6gj_pu63pmx1X6SdSHia9g5A_jpBbze7r-hr7VuA3w_3nO0vr15Wt5nqz93D8urVWbSfjGjIEESUxa6pDmQUhu94bqwRkjGBOGMkU1V54LIutJcWA7GipqSouJMVEzwOfp10N364d8IIarOBQNtq3sYxqCo5JxxUiY_5ujnB7QZRt-n7RKVF6Is0pmo4kCZ5FzwUKutd532e0WJmqJRjTpGo6ZoFJkqT3M_jurjpgP7PvWWRQIuDwAkO3YOvAommWvAOp8CUnZwn3zxH3KiokU</recordid><startdate>20171015</startdate><enddate>20171015</enddate><creator>Joseph, Susan M.</creator><creator>Manghelli, Joshua L.</creator><creator>Vader, Justin M.</creator><creator>Keeney, Tamra</creator><creator>Novak, Eric L.</creator><creator>Felius, Joost</creator><creator>Martinez, Sara C.</creator><creator>Nassif, Michael E.</creator><creator>Lima, Brian</creator><creator>Silvestry, Scott C.</creator><creator>Rich, Michael W.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7200-8755</orcidid></search><sort><creationdate>20171015</creationdate><title>Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy</title><author>Joseph, Susan M. ; Manghelli, Joshua L. ; Vader, Justin M. ; Keeney, Tamra ; Novak, Eric L. ; Felius, Joost ; Martinez, Sara C. ; Nassif, Michael E. ; Lima, Brian ; Silvestry, Scott C. ; Rich, Michael W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-1e9e90c65a614e06acab3a5dc8922803220b7f4809f7a38d3ecd8f10573287283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adults</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiovascular disease</topic><topic>Confidence intervals</topic><topic>Criteria</topic><topic>Exhaustion</topic><topic>Extubation</topic><topic>Female</topic><topic>Frail Elderly - 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Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Joseph, Susan M.</au><au>Manghelli, Joshua L.</au><au>Vader, Justin M.</au><au>Keeney, Tamra</au><au>Novak, Eric L.</au><au>Felius, Joost</au><au>Martinez, Sara C.</au><au>Nassif, Michael E.</au><au>Lima, Brian</au><au>Silvestry, Scott C.</au><au>Rich, Michael W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2017-10-15</date><risdate>2017</risdate><volume>120</volume><issue>8</issue><spage>1349</spage><epage>1354</epage><pages>1349-1354</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28843393</pmid><doi>10.1016/j.amjcard.2017.07.074</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-7200-8755</orcidid></addata></record> |
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| subjects | Adults Age Aged Aged, 80 and over Cardiovascular disease Confidence intervals Criteria Exhaustion Extubation Female Frail Elderly - statistics & numerical data Frailty Geriatric Assessment - methods Grip strength Heart Heart diseases Heart failure Heart Failure - mortality Heart Failure - therapy Heart surgery Heart-Assist Devices Hospitals Humans Implantation Inpatients Liver diseases Male Middle Aged Mortality Odds Ratio Older people Patients Prospective Studies Risk Assessment - methods Risk Factors Surgery Survival Rate - trends Therapy Transplants & implants United States - epidemiology Ventilators Ventricle Ventricular assist devices |
| title | Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy |
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