The impact of frailty on mortality after heart transplantation

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:40

Article

Macdonald, Peter S.^1,2,3  Gorrie, Natasha¹  Brennan, Xavier^1,2  Aili, Samira R.^1,4  De Silva, Ricardo¹  Jha, Sunita R.^1,4  Fritis-Lamora, Rodrigo¹  Montgomery, Elyn¹  Wilhelm, Kay^2,5  Pierce, Rachel¹  Lam, Fiona¹  Schnegg, Bruno¹  Hayward, Christopher^1,2,3  Jabbour, Andrew^1,2,3  Kotlyar, Eugene^1,2  Muthiah, Kavitha^1,2,3  Keogh, Anne M.^1,2  Granger, Emily¹  Connellan, Mark¹  Watson, Alasdair¹  Iyer, Arjun¹  Jansz, Paul C.¹ 

[1] St Vincents Hosp, Heart Transplant Unit, Sydney, NSW 2010, Australia

[2] Univ New South Wales, Fac Med, Sydney, NSW, Australia

[3] Victor Chang Cardiac Res Inst, Transplantat Res Lab, Sydney, NSW, Australia

[4] Univ Notre Dame, Sch Med, Sydney, NSW, Australia

[5] St Vincents Hosp, Consultat Liaison Psychiat, Sydney, NSW, Australia

关键词: frailty;    cognitive impairment;    heart transplantation;    mortality;    duration of hospitalization;   

DOI  :  10.1016/j.healun.2020.11.007

来源: Elsevier

【 摘 要 】

BACKGROUND: Frailty is prevalent in the patients with advanced heart failure; however, its impact on clinical outcomes after heart transplantation (HTx) is unclear. The aim of this study was to assess the impact of pre-transplant frailty on mortality and the duration of hospitalization after HTx. METHODS: We retrospectively reviewed the post-transplant outcomes of 140 patients with advanced heart failure who had undergone frailty assessment within the 6-month interval before HTx: 43 of them were frail (F) and 97 were non-frail (NF). RESULTS: Post-transplant survival rates for the NF cohort at 1 and 12 months were 97% (93-100) and 95% (91-99) (95% CI), respectively. In contrast, post-transplant survival rates for the F cohort at the same time points were 86% (76-96) and 74% (60-84) (p < 0.0008 vs NF cohort), respectively. The Cox proportional hazards regression analysis demonstrated that pre-transplant frailty was an independent predictor of posttransplant mortality with a hazard ratio of 3.8 (95% CI: 1.4-10.5). Intensive care unit and hospital length of stay were 2 and 7 days longer in the F cohort (both p < 0.05), respectively, than in the NF cohort. CONCLUSIONS: Frailty within 6 months before HTx is independently associated with increased mortality and prolonged hospitalization after transplantation. Future research should focus on the development of strategies to mitigate the adverse effects of pre-transplant frailty. (C) 2020 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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