Impact of Frailty on Health-Related Quality of Life from before to 6 Months after Surgery: Findings from the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) Study

Abstract

Purpose In patients (pts) with advanced HF, frailty is independently associated with adverse outcomes after heart transplantation (HT) and durable mechanical support as destination therapy (DT-MCS). We compared frailty, using the 5-meter gait speed (GS) test, before and 6 months (mos) after surgery in 60-80-year-old pts undergoing HT (with or without MCS) and DT-MCS. Methods A standardized GS test was attempted on all pts at baseline and 6 months post-surgery. The average of 3 measurements was recorded at each time point. HRQOL was assessed by the EQ-5D-3L Visual Analog Scale (VAS) and KCCQ-12 summary score. Statistical analyses included t-tests, chi-square tests, and Pearson correlation coefficients. Results We analyzed data on 163 pts from 13 U.S. sites awaiting HT (n= 130; 68 with MCS and 62 without MCS) and DT-MCS (n=33) between 10/1/15-9/15/18, who were able to complete the GS test at baseline and 6 mos. The most common reason for GS test non-completion was too sick. DT MCS pts were on average older (DT = 67.4 ± 5.4 vs HT MCS = 64.8 ± 3.4 vs HT non-MCS = 63.8 ± 2.6 years, p Conclusion Physical frailty is more common in elderly pts who undergo DT-MCS vs pts who receive HT. Findings from our study also suggest that physical frailty is reversible in pts with advanced HF. Improvement in physical frailty after HT and DT-MCS is associated with better HRQOL early after surgery.