Benefits of Both Physical Assessments and Electronic Health Record Information to Assess Frailty Prior to Heart Transplant

Abstract

<h3>Purpose</h3> Frailty is the deterioration of physiological reserve, decreasing resiliency to health stressors. Frail patients awaiting heart transplant are at risk for adverse outcomes after transplant, but the optimal way to assess frailty prior to transplant remains unknown. This study examined the relationship between physical and chart review based frailty assessments in heart transplant candidates and evaluated each assessment with respect to transplant status. <h3>Methods</h3> In this single-center, observational study, 44 heart transplant candidates were assessed for frailty using three methods. Short Physical Performance Battery (SPPB) and Fried Frailty Phenotype (FFP) were used as two physical assessments of frailty. Frailty Risk Score (FRS) was used as a chart review assessment of 20 different biopsychosocial and functional components, including biomarkers, depression, social support, cognitive impairment and sleep. We then determined the correlation between SPPB, FFP, and FRS and the difference in frailty status for three clinical outcomes: waitlist status, transplant status and mortality. <h3>Results</h3> Of 44 participants, mean age was 60 years. Mean SPPB score was 7.1 out of 12, mean FFP score was 3.1 out of 5, and mean FRS was 7.1 out of 20. FRS significantly correlated with SPPB and FFP (R² = 0.101, p = 0.043; R² = 0.313, p = <0.001, respectively). As measured by the SPPB and FRS, patients added to the waitlist were less frail than those who were not accepted (p = 0.022; p = 0.002), and patients who were successfully transplanted were less frail than those who were not (p = 0.026; p = 0.008). In contrast, mortality was associated with physical frailty assessment as measured by SPPB and FFP, patients who died were more frail than those who survived (p = 0.010; p = 0.025, respectively). <h3>Conclusion</h3> SPPB and chart review FRS are potential predictors of waitlist and transplant status in heart transplant candidates, whereas SPPB and FFP were associated with mortality. Research in a larger cohort is ongoing.