Assessing Frailty in Patients Undergoing Destination Therapy Left Ventricular Assist Device: Observations from Interagency Registry for Mechanically Assisted Circulatory Support.

Abstract

Frailty and heart failure share common pathways with symptoms that often coexist. Assessment of frailty may inform patient selection for left ventricular assist device (LVAD) therapy. Using Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) data of destination therapy (DT) LVAD patients from January 1, 2012, to March 31, 2014, we examined preimplantation provider-assessed frailty and gait speed testing and the association with 1 year postimplantation outcomes. Of 2,469 patients, 227 (9.2%) had provider-assessed frailty. Only 320 (13.0%) completed gait speed testing, whereas 1,047 (42.4%) were "too sick" to perform the test. Provider-assessed frail and nonfrail patients had similar distributions of INTERMACS profiles and similar median gait speeds. One year mortality was higher for patients with provider-assessed frailty versus nonfrail (24.6% vs. 18.9%; p = 0.01) and for those too sick to complete gait speed testing versus completed testing (22.0% vs. 15.9%). There was an association between provider-assessed frailty and mortality, although it was not clinically significant after adjustment (hazard ratio [HR]: 1.38 [95% confidence interval {CI}: 0.97-1.95]). Useful information regarding frailty on postimplant mortality is gained from provider assessment of frailty or knowing gait speed could not be performed. Development of frailty measures better suited for DT LVAD candidates may help in distinguishing between a frailty phenotype and a more reversible from heart failure-related vulnerability.