Abstract
Purpose Very little is known about frailty in patients with a left ventricular assist device (LVAD) in general, and about reversibility of different measures of frailty post LVAD in particularly. The purpose of the study was to determine which measures of frailty improve post LVAD implantation. Methods This was an observational, longitudinal (3 month) cohort study of 25 patients with advanced heart failure who underwent LVAD implantation between January 2015 and May 2016. Demographic and clinical data were retrieved from hospital medical records. The six minute walk test (6MWT) was conducted by physical therapist and hand grip strength was assessed by a nurse practitioner using a hand dynamometer. Paired t-test was used to determine differences between pre and post 6MWT, handgrip strength and serum albumin levels. Demographic and clinical characteristics were reported using frequencies, percentages for categorical variables and mean ± standard deviation for continuous variables. Results A majority of the patients were male (88%) and over 40% of the patients in the study were under the age of 60. The primary etiology of heart failure for his population was ischemic cardiomyopathy (60%). Complete data were collected on 23 patients. One patient died within 3 months of LVAD implant and one patient was wheelchair bound post LVAD implant. The mean pre-operative albumin level was 2.7 ± .4 mg/dL with only 4% of patients having an albumin levels > 3.5 mg/dl. The albumin became normal after surgery (see Table). Only 8% of patients walked 300 feet or more in 6 minutes pre-implant. In contrast 53% were able to walk more than 300 feet at 3 months post-implant. There was no difference in hand grip strength. Conclusion Albumin levels and 6MWT significantly improved 3 months post LVAD implant, while hand grip strength noted no improvement. Short 6MWT distance and low albumin should not preclude LVAD implant because these measures of frailty are reversible and are likely to improve shortly after surgery.
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