Abstract 20539: Frailty Assessment in Advanced Heart Failure

Abstract

Introduction: There is growing literature supporting the significance of frailty in a broad array of cardiovascular diseases. To our knowledge, there are no studies specifically examining the application of frailty assessment to an advanced heart failure population. Methods: Forty consecutive elderly (>65 yrs of age) subjects were enrolled from the heart failure clinic at Montefiore Medical Center, if they had advanced heart failure as defined by: LVEF < 35%, NYHA Class 3 or 4, and a 6 minute walk (6mwt) < 300 meters. At baseline, subjects were assessed for frailty with the Fried Frailty Index, which consists of 5 components: hand grip strength (HGS), 15 meter walk time (WT), weight loss, low physical activity and exhaustion. Each component is assigned a score of 0 or 1 and summed for the total score: 0 = not frail, 1-2 = intermediately frail, ≥3 = frail. Subjects were prospectively followed at 3 month intervals for mortality or heart failure related hospitalizations. Results: Follow-up was available for 38 subjects at a median length of 437 days (range: 12-549). At baseline, the mean age of the cohort was 74±7 yrs, LVEF 27±7%, and 6mwt 189±80m. None of the patients tested were not frail, 32% (12) were intermediately frail, and 68% (26) were frail. More patients in the frail group (N=7) expired during follow up then those in the intermediately frail group (N=1) although this did not reach statistically significance (Figure; 1). Since there was a limited spectrum of frailty in this cohort, HGS and WT were assessed as continuous measures for association with outcomes. Both objective tools demonstrated a strong trend towards mortality (p=0.08). There was no association between the composite or individual score and hospitalizations. Conclusions: In this pilot study of frailty assessment in advanced heart failure, the objective tools of WT and HGS tended to be associated with mortality. These preliminary results warrant further investigation.