Effects of frailty and cognitive function on post-operative mortality of patients scheduled to undergo left ventricular assist device implantation

Introduction: Frailty has been associated with morbidity and mortality in patients with heart failure and those undergoing cardiac surgery. Thus, assessment of frailty may help identify the patients that would likely experience adverse outcomes. Purpose: We aimed to study the relationship between frailty and the cardiovascular outcomes in LVAD population. Methods: All patients scheduled to undergo LVAD implantation between 2017 and 2018 were preoperatively assessed for frailty, cognitive function (by means of Mini-Cog) and depression (with Patient Health Questionnaire). Fried's frailty phenotype was used to evaluate frailty (frail ≥3/5). Patients were observed for adverse events for 3 months. Results: A total of 52 patients (44 men; aged 52 ± 8 years) were included. According to the Fried phenotype, 29 patients (55%) were designated as frail. Frail patients had higher NT-proBNP values, higher NYHA class, and depression while frailty was associated with lower body mass index and body surface area. Frailty increased the risk of in-hospital mortality or prolonged length of stay with 21 (72%) frail patients meeting the primary endpoint compared to 9 (39%) non-frail patients (p=0.01). Of the secondary outcomes, only postoperative ventricular arrhythmias reached statistical significance with being more common among frail patients than non-frail ones (p=0.01). Conclusion: Frailty was associated with increased in-hospital mortality or prolonged length of stay among LVAD patients. We recommend including frailty as a criterion for the selection of patients for LVAD.