Abstract
Background
Frailty has been identified as a risk factor for adverse clinical outcomes after cardiac
intervention or surgery. However, whether it increases the risk of adverse outcomes
in patients undergoing left ventricular assist device (LVAD) therapy has been controversial.
Therefore, we conducted a systematic review and meta-analysis of the frailty measures
and clinical outcomes of length of stay and mortality in this setting.
Methods
PubMed and Embase were searched until September 11, 2017, for studies evaluating the
association between frailty and clinical outcomes in advanced heart failure patients
undergoing LVAD implantation.
Results
A total of 46 and 79 entries were retrieved from our search strategy. A total of 13
studies involving 3435 patients were included in the final meta-analysis (mean age:
57.7 ± 15.3 years; 79% male, follow-up duration was 13 ± 14 months). Compared to nonfrail
patients (n = 2721), frail patients (n = 579) had significantly longer time-to-extubation
(n = 3; mean difference: 45 ± 6 hours; I2: 0%) and hospital length of stay (n = 4; mean difference: 2.9 ± 1.2 days; P = .001; I2: 21%). Frailty was not a predictor of inpatient or short-term mortality [n = 3; hazard
ratio (HR): 1.22, 95% confidence interval (CI): 0.66-2.26; P > .05; I2: 0%] but predicted long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P = .001; I2: 0%).
Conclusions
Frailty leads to significantly longer time to extubation, hospital length of stay,
and long-term mortality in advanced heart failure patients who have undergone LVAD
implantation. Older patients being considered for LVAD implantation should therefore
be assessed for frailty status. The risk and benefit of the procedure should be explained
to the patient, emphasizing that frailty increases the likelihood of adverse clinical
outcomes.
Keywords
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Article info
Publication history
Published online: November 09, 2017
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
