Association of Fried's Frailty Score and Sarcopenia with Outcomes After Heart Transplantation

Abstract

PurposeMeasures of frailty, including Fried's Frailty Assessment (FFA) and skeletal muscle sarcopenia, as predictors of outcomes are well established with left ventricular assist devices. However, their association is not well-characterized in patients undergoing heart transplantation (HT). We performed a retrospective study to evaluate the outcomes of HT in frail patients.MethodsPatient who received HT at our medical center between 2019 and 2021 were reviewed. Perioperative FFA score ≥ 3 was defined as frail. Skeletal muscle indexes were measured using preoperative computed tomography imaging of the psoas and pectoralis major and minor muscles areas and indexed to body surface area. Sarcopenia was defined per the lowest skeletal muscle tertile with total psoas area index ≤4.24 and pectoralis muscle index ≤7.40.ResultsOf the 71 patients who had HT, 13 met criteria for frailty based on FFA. When combined with frailty based on sarcopenia, 19 additional patients met criteria. Thirty-two patients were in the frail group based on FFA and sarcopenia, and thirty-nine patients were in the non-frail group. Although there was no difference between the frail and non-frail groups in age or body mass index, the frail group had more women (n=11, 34.4% vs. n=5, 12.8%, p=0.03). While there was no difference in total hospital length of stay (LOS), the frail group had a trend toward increased intensive care unit LOS (23.8 vs. 12.2 days, p=0.06). On Kaplan-Meier analysis, the frail group had higher rates of composite outcome of one-year readmission and all-cause mortality (log-rank p=0.018, Figure 1).ConclusionIn a single-center cohort, frail patients who underwent HT had significantly worse readmission and survival outcomes at one year. Sarcopenia assessment allows for higher sensitivity in identifying patients with frailty, who are at risk for poor outcomes. Measures of frailty, including Fried's Frailty Assessment (FFA) and skeletal muscle sarcopenia, as predictors of outcomes are well established with left ventricular assist devices. However, their association is not well-characterized in patients undergoing heart transplantation (HT). We performed a retrospective study to evaluate the outcomes of HT in frail patients. Patient who received HT at our medical center between 2019 and 2021 were reviewed. Perioperative FFA score ≥ 3 was defined as frail. Skeletal muscle indexes were measured using preoperative computed tomography imaging of the psoas and pectoralis major and minor muscles areas and indexed to body surface area. Sarcopenia was defined per the lowest skeletal muscle tertile with total psoas area index ≤4.24 and pectoralis muscle index ≤7.40. Of the 71 patients who had HT, 13 met criteria for frailty based on FFA. When combined with frailty based on sarcopenia, 19 additional patients met criteria. Thirty-two patients were in the frail group based on FFA and sarcopenia, and thirty-nine patients were in the non-frail group. Although there was no difference between the frail and non-frail groups in age or body mass index, the frail group had more women (n=11, 34.4% vs. n=5, 12.8%, p=0.03). While there was no difference in total hospital length of stay (LOS), the frail group had a trend toward increased intensive care unit LOS (23.8 vs. 12.2 days, p=0.06). On Kaplan-Meier analysis, the frail group had higher rates of composite outcome of one-year readmission and all-cause mortality (log-rank p=0.018, Figure 1). In a single-center cohort, frail patients who underwent HT had significantly worse readmission and survival outcomes at one year. Sarcopenia assessment allows for higher sensitivity in identifying patients with frailty, who are at risk for poor outcomes.