Feasibility of Incorporating Frailty Testing into Standard Assessment of Heart Transplant Candidacy

Abstract

Frailty is common among patients with advanced heart failure referred for transplant evaluation. Although frailty increases mortality risk, frailty testing is not part of standard transplant candidacy evaluations. As part of a comprehensive evaluation, we explored the feasibility of performing routine frailty assessments on transplant candidates. Frailty evaluation included two well-validated assessments: Fried's Frailty Phenotype (FFP) and the Short Physical Performance Battery (SPPB), performed during inpatient hospitalization. Based on each assessment, patients were categorized as frail, pre-frail, or non-frail. The results of the frailty testing were presented during the selection committee meeting as part of a multidisciplinary evaluation. Over 14 months, 29 patients with advanced heart failure underwent frailty assessments. The mean age was 62.5 years and 21% were women. The average FFP and SPPB scores were 3.1 and 6.7, respectively. There was no significant correlation between age and frailty scores. Of the patients listed for transplant (n = 17), 23%, 29%, and 41% were frail, pre-frail, and non-frail, respectively, while 100% of those who were declined listing (n = 7) were frail. Patients who underwent transplant were significantly less frail than patients who were not transplanted (FFP: 2.2 vs 3.5, p = 0.02; SPPB: 9.8 vs 5.2, p < 0.001). Patients who died were significantly more frail than those who remained alive (n = 7 vs 21; FFP: 2.6 vs. 4.4, p < 0.001; SPPB: 3.9 vs 7.7). Frailty assessments can be successfully incorporated into a comprehensive evaluation for heart transplant candidacy. Although the presence of frailty is not a contraindication for transplant, frail patients undergoing heart transplant evaluation are less likely to be transplanted and more likely to die. The presence of frailty can help identify patients who may benefit from additional support services to optimize quality of life and define goals of care.