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.
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.
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%).
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Frailty: An emerging research and clinical paradigm—issues and controversies.J Gerontol A Biol Sci Med Sci. 2007; 62: 731-737
- Frailty and mortality outcomes after percutaneous coronary intervention: A systematic review and meta-analysis.J Am Med Dir Assoc. 2017;
- The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: A systematic review and meta-analysis.Eur Heart J Qual Care Clin Outcomes. 2017; 3: 123-132
- Reduced handgrip strength as a marker of frailty predicts clinical outcomes in patients with heart failure undergoing ventricular assist device placement.J Card Fail. 2014; 20: 310-315
- Assessing frailty in patients undergoing destination therapy left ventricular assist device: Observations from interagency registry for mechanically assisted circulatory support.ASAIO J. 2017;
- Frailty and outcomes after implantation of left ventricular assist device as destination therapy.J Heart Lung Transplant. 2014; 33: 359-365
- The impact of frailty in an elderly population on outcomes after destination therapy LVAD placement: The Greater New York Geriatric Cardiology Consortium.J Card Fail. 2014; 21: S94
- Usefulness of psoas muscle area determined by computed tomography to predict mortality or prolonged length of hospital stay in patients undergoing left ventricular assist device implantation.Am J Cardiol. 2016; 118: 1363-1367
- Reversibility of frailty after bridge-to-transplant ventricular assist device implantation or heart transplantation.Transplant Direct. 2017; 3: e167
- Prospective assessment of frailty using the Fried criteria in patients undergoing left ventricular assist device therapy.Am J Cardiol. 2017; 120: 1349-1354
- Frailty is associated with increased time on ventilator in patients undergoing left ventricular assist device implantation: A prospective study.J Heart Lung Transplant. 2014; 33: S36
- Frailty is highly prevalent in patients being considered for a left ventricular assist device and is associated with depression and reduced quality of life.J Card Fail. 2016; 22: S110-S111
- Cachexia is common in ventricular assist device recipients but not predictive of mortality.J Card Fail. 2016; 22: S57-S58
- Sarcopenia is associated with increased post left ventricular assist device implantation morbidity.J Heart Lung Transplant. 2014; 33: S212
- Handgrip strength is a predictor for length of stay in patients implanted with left ventricular assist devices.J Heart Lung Transplant. 2015; 34: S189-S190
Fan K, Wong M, Cheng K, et al. Frailty conferred incremental prognostic significance in Chinese heart failure patients with advanced heart failure. Heart Failure 2017 and the 4th World Congress on Acute Heart Failure. 19. France: European Journal of Heart Failure; 2017:416.
- From bedside to bench: Research agenda for frailty.Sci Aging Knowledge Environ. 2005; 2005: pe24
- Frailty and hospitalization of long-term stay nursing home residents.J Am Geriatr Soc. 1997; 45: 265-269
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- Prolonged ventilator dependence following LVAD implant is an independent predictor of reduced survival.J Heart Lung Transplant. 2017; 36: S435
- Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices.Circ Heart Fail. 2011; 4: 779-784
- Left ventricular assist device implantation after acute anterior wall myocardial infarction and cardiogenic shock: A two-center study.J Thorac Cardiovasc Surg. 2005; 130: 693-698
- Treatment options for patients with mobile left ventricular thrombus and ventricular dysfunction: A case series.Heart Lung Vessel. 2014; 6: 88-91
- Frailty, inflammation, and cardiovascular disease: Evidence of a connection.Am J Geriatr Cardiol. 2008; 17: 101-107
- Frailty has a stronger association with inflammation than age in older veterans.Immun Ageing. 2016; 13: 27
- Reactive oxygen species, endoplasmic reticulum stress and mitochondrial dysfunction: The link with cardiac arrhythmogenesis.Front Physiol. 2016; 7: 313
- Electrophysiological mechanisms of gastrointestinal arrhythmogenesis: Lessons from the heart.Front Physiol. 2016; 7: 230
- Nutrition, frailty, and sarcopenia.Aging Clin Exp Res. 2017; 29: 43-48
- Preoperative malnutrition is associated with poor clinical outcomes in patients undergoing left ventricular assist device (LVAD) implantation.ASAIO J. 2004; 50: 119
- Preoperative nutritional assessment with the Prognostic Nutrition Index in patients undergoing left ventricular assist device implantation.ASAIO J. 2017;
- Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: Lessons from the Cardiovascular Health Study.J Am Geriatr Soc. 2008; 56: 898-903
- The ability of three different models of frailty to predict all-cause mortality: Results from the European Male Aging Study (EMAS).Arch Gerontol Geriatr. 2013; 57: 360-368
Published online: November 09, 2017
The authors declare no conflicts of interest.
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.