1. A, Breakdown of frailty into its underlying causes, manifestations, and clinical outcomes separated by LVAD-responsive and LVAD-independent causes of frailty.
A, Breakdown of frailty into its underlying causes, manifestations, and clinical outcomes separated by LVAD-responsive and LVAD-independent causes of frailty. Frailty is a heightened state of vulnerability in the face of stress and results from the accumulation of multimorbidity, aging, and disability. In advanced heart failure with reduced left ventricular ejection fraction, a patient's heart failure contributes significantly to the frailty syndrome and is potentially reversible with LVAD (LVAD-responsive frailty). However, many patients with advanced heart failure may be frail due to illness unrelated to heart failure severity, which is not treatable with LVAD (LVAD-independent frailty). Heart failure-related and nonheart failure-related factors combine to adversely affect health outcomes through several common effectors of frailty. LVAD indicates left ventricular assist device; PCWP, pulmonary capillary wedge pressure; CVP, central venous pressure; COPD, chronic obstructive pulmonary disease; LOS, length of stay; ICU, intensive care unit; ADLs, activities of daily living. B, Patients undergoing DT LVAD with similar total baseline frailty but differing underlying causes of frailty. Patient A, with primarily LVAD-responsive frailty (ie, mostly heart failure-related illness), is likely to experience a good outcome if he or she survives the early postoperative period. Conversely, Patient C, with primarily LVAD-independent frailty (ie, mostly noncardiac-related illness), is at greater risk of death, complications (eg, stroke, gastrointestinal bleed, or chronic hemolytic anemia) and/or persistently poor functional status after LVAD placement. Of note, most DT patients are more like Patient B with evidence of significant LV dysfunction warranting LVAD but also significant comorbidity and/or advanced age disqualifying them from transplantation. DT indicates destination therapy; LVAD, left ventricular assist device.
Kelsey M. Flint et al. Circ Heart Fail. 2012;5:
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