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

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<0.001) and had more co-morbidities than HT pts (DT = 5.4 ± 1.9 vs HT MCS = 4.0 ± 1.8 vs HT non-MCS = 3.9 ± 1.8, p<0.001). At baseline, GS was significantly slower in DT pts compared to both HT groups. By 6 months after surgery, all 3 groups showed significant improvement in GS, and at 6 mos, there were no significant differences in GS among groups (figure 1, panel A). Baseline GS was significantly associated with HRQOL only in the HT non-MCS group (figure 1, panel B and C) but, 6 mo GS was positively correlated with the KCCQ-12 score in all 3 groups of pts (Figure 1, panel D and E). 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. 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. 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. 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<0.001) and had more co-morbidities than HT pts (DT = 5.4 ± 1.9 vs HT MCS = 4.0 ± 1.8 vs HT non-MCS = 3.9 ± 1.8, p<0.001). At baseline, GS was significantly slower in DT pts compared to both HT groups. By 6 months after surgery, all 3 groups showed significant improvement in GS, and at 6 mos, there were no significant differences in GS among groups (figure 1, panel A). Baseline GS was significantly associated with HRQOL only in the HT non-MCS group (figure 1, panel B and C) but, 6 mo GS was positively correlated with the KCCQ-12 score in all 3 groups of pts (Figure 1, panel D and E). 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.