A Novel Frailty Score And Outcomes in Patients Supported with a Left Ventricular Assist Device

PurposeThe assessment of frailty remains an integral part in selecting patients for durable left ventricular assist device (LVAD). A standard objective multi-disciplinary approach is needed.MethodsFrom March 2019-July 2021, a novel frailty score was applied to 54 patients with the following components: hand grip strength (0=strong/ normal; 2=weak, normalized to age/gender), nutritional status by registered dietician (0= standard risk; 1= intermediate risk; 2=high risk); Timed Up and Go (TUG) test (0 pts < 10 seconds; 1 pt - 11-20 seconds; 2 pts - > 20 seconds or patient unwilling, unable or required assistance), cognitive function (draw clock hands to indicate a time of ‘ten after eleven’ (0= no errors, 1= minor spacing errors, 2=more errors), mood (sad or depressed; 0=no, 1= sometimes, 2=often), anemia (Hgb < 13 for men and < 12 for women (but greater than values below): 1 pt; Hgb < 10 for men and < 9 for women: 2 pts.) Cumulative scores are grouped as not or mildly frail (0-3, Group 1), moderate-severely frail (4-12, Group 2) or no score obtainable (Group 3).ResultsGroup 3 had the worst one year post-implant survival (Figure 1), the longest median post-implant length of stay (Figure 2), the highest rolling 12-month rates of unplanned RVAD use (25% compared to 0%) and highest rates of CVA within 6 months of implant (20% compared to 0%).ConclusionPatients too sick and unable to complete a frailty score had the worst outcomes post LVAD implant. These data underscore the importance of a standard objective assessment of frailty in the selection of LVAD candidates. The assessment of frailty remains an integral part in selecting patients for durable left ventricular assist device (LVAD). A standard objective multi-disciplinary approach is needed. From March 2019-July 2021, a novel frailty score was applied to 54 patients with the following components: hand grip strength (0=strong/ normal; 2=weak, normalized to age/gender), nutritional status by registered dietician (0= standard risk; 1= intermediate risk; 2=high risk); Timed Up and Go (TUG) test (0 pts < 10 seconds; 1 pt - 11-20 seconds; 2 pts - > 20 seconds or patient unwilling, unable or required assistance), cognitive function (draw clock hands to indicate a time of ‘ten after eleven’ (0= no errors, 1= minor spacing errors, 2=more errors), mood (sad or depressed; 0=no, 1= sometimes, 2=often), anemia (Hgb < 13 for men and < 12 for women (but greater than values below): 1 pt; Hgb < 10 for men and < 9 for women: 2 pts.) Cumulative scores are grouped as not or mildly frail (0-3, Group 1), moderate-severely frail (4-12, Group 2) or no score obtainable (Group 3). Group 3 had the worst one year post-implant survival (Figure 1), the longest median post-implant length of stay (Figure 2), the highest rolling 12-month rates of unplanned RVAD use (25% compared to 0%) and highest rates of CVA within 6 months of implant (20% compared to 0%). Patients too sick and unable to complete a frailty score had the worst outcomes post LVAD implant. These data underscore the importance of a standard objective assessment of frailty in the selection of LVAD candidates.