Update on Association of Fried's Frailty Score and Sarcopenia After Left Ventricular Assist Device Implantation

Abstract

<h3>Purpose</h3> While Fried's Frailty Assessment (FFA) is well-validated, it does include subjective components in its frailty assessment. The assessment of skeletal muscle density has recently emerged as an objective biomarker for frailty in patients with left ventricular assist device (LVAD) placement. The additive value of sarcopenia to existing frailty assessments and its association with outcomes in patients undergoing LVAD implantation requires further clarification. <h3>Methods</h3> We evaluated 43 patients who underwent LVAD implantation at our medical center between January 2018 and July 2021. Perioperative FFA score ≥ 3 was defined as frail. Skeletal muscle indexes were measured using preoperative computed tomography imaging of the psoas and pectoralis muscles areas. Sarcopenia was defined per the lowest skeletal muscle tertile with total psoas area index ≤4.45 or pectoralis muscle index ≤4.50. All time to event analysis excluded patients who died during their admission for LVAD. <h3>Results</h3> Of the 43 patients who had LVAD placement, eight patients met criteria for frailty based on FFA. When combined with frailty based on sarcopenia, 13 additional patients met criteria. The frail group had significantly lower albumin (3.33 vs. 3.78, p=0.046). There were no differences in age (54.1 vs 53.6 years, p=0.54) or BMI (27.6 vs. 31.1, p=0.15) between the frail and non-frail groups. Although the frail group had a greater proportion of patients with major bleed after discharge (38.1% vs. 13.6%), there was no significant difference in days to major bleed between both groups (log-rank p=0.112). The frail group had significantly higher rates of composite outcome of 30-day readmission and all-cause mortality (log-rank p=0.042), (Figure 1). <h3>Conclusion</h3> While FFA is a commonly used tool with subjective components for assessing frailty in patients with heart failure, the addition of objective sarcopenia biomarkers identifies additional patients with frailty, who are at risk for worse outcomes.