(574) Comparison of Chart-Based and Physical Frailty Assessment in Heart Transplant Candidates to Predict Clinical Outcomes

PurposeAs the population ages, the number of older adults assessed for heart transplant candidacy is notably increasing. However, it is not clear how best to assess risk beyond chronological age for this population. Our study focuses on the use of a biopsychosocial, chart-based frailty assessment in comparison with physical frailty assessments to attempt to predict clinical outcomes for heart transplant patients.Methods175 patients undergoing heart transplant evaluation were eligible for this single center observational study. Assessments were performed on all patients aged 55 years or older as well as in selected younger patients with clinical concern for frailty raised by the treating team. We conducted four frailty assessments: Short Physical Performance Battery (SPPB), Fried Frailty Phenotype (FFP), a 20-item Frailty Index (FI20), and Frailty Risk Score (FRS).ResultsIn this study, FFP was weakly correlated with FRS (p=0.001, r2=0.224) while SPPB did not correlate with FRS (p=0.066, R2=0.075). None of the frailty assessments correlated with age. Pre-transplant frailty measured by SPPB was associated with failure to undergo transplant (p=0.035), but not by FFP or FRS. FRS was associated with 6-month readmission after transplant (p=0.029) while SPPB and FFP were not. SPPB and FFP were associated with mortality (p=0.022, p=0.008 respectively) while FRS was not (Figure).ConclusionChart review-based frailty assessments show potential prognostic value for older heart transplant candidates. These frailty assessments may be less time-consuming, virtual alternatives to physical frailty assessments that must be done in-person. In addition, chart-review frailty assessments have different associations with clinical outcomes, such as mortality, compared with physical frailty assessments. Future work should incorporate these measures into prognostic models and consider interventions for patients identified as frail, such as prehabilitation. As the population ages, the number of older adults assessed for heart transplant candidacy is notably increasing. However, it is not clear how best to assess risk beyond chronological age for this population. Our study focuses on the use of a biopsychosocial, chart-based frailty assessment in comparison with physical frailty assessments to attempt to predict clinical outcomes for heart transplant patients. 175 patients undergoing heart transplant evaluation were eligible for this single center observational study. Assessments were performed on all patients aged 55 years or older as well as in selected younger patients with clinical concern for frailty raised by the treating team. We conducted four frailty assessments: Short Physical Performance Battery (SPPB), Fried Frailty Phenotype (FFP), a 20-item Frailty Index (FI20), and Frailty Risk Score (FRS). In this study, FFP was weakly correlated with FRS (p=0.001, r2=0.224) while SPPB did not correlate with FRS (p=0.066, R2=0.075). None of the frailty assessments correlated with age. Pre-transplant frailty measured by SPPB was associated with failure to undergo transplant (p=0.035), but not by FFP or FRS. FRS was associated with 6-month readmission after transplant (p=0.029) while SPPB and FFP were not. SPPB and FFP were associated with mortality (p=0.022, p=0.008 respectively) while FRS was not (Figure). Chart review-based frailty assessments show potential prognostic value for older heart transplant candidates. These frailty assessments may be less time-consuming, virtual alternatives to physical frailty assessments that must be done in-person. In addition, chart-review frailty assessments have different associations with clinical outcomes, such as mortality, compared with physical frailty assessments. Future work should incorporate these measures into prognostic models and consider interventions for patients identified as frail, such as prehabilitation.