Frailty Phenotype Is Associated With 1-Year Outcomes In Ambulatory Advanced Heart Failure: A Report From The Revival Registry

Introduction: The Fried Frailty Phenotype (FFP), defined by weakness, slowness, inactivity, exhaustion and weight loss, predicts adverse outcomes in geriatric populations but has not been studied in advanced heart failure (AHF). The REVIVAL study prospectively collected frailty measures in ambulatory patients with advanced HF to determine relevant components of frailty in this population and the impact on clinical outcomes. Hypothesis: We hypothesize that measures of frailty will be strongly associated with the 1 yr composite outcome of LVAD, UNOS 1A/ B cardiac transplant or death. Methods: The REVIVAL registry enrolled ambulatory patients with AHF on oral Rx (INTERMACS Profiles 4-7). A modified FFP was defined by 5 components:1) weakness: hand grip strength <25% of body weight; 2) slowness: 5-m gait time <6 seconds; 3) weight loss > 10lbs in the past yr; 4) inactivity from 5 Kansas City Cardiomyopathy Questionnaire (KCCQ) activity questions and 5) exhaustion from 2 KCCQ exhaustion questions. A score of 0-1 was deemed not frail, 2 was pre-frail, and ≥3 was considered frail. Event-free survival for each group was determined by the Kaplan-Meier method and the increased hazards of pre-frailty and frailty compared to non-frailty were determined with proportional hazards modeling. Results: Frailty was present in 18% of the 335 patients with complete 5-component FFP data, pre-frailty in 41%, and non-frailty in 41%. During the first year, 89 outcome events occurred, with HR 2.5 (p=0.003, 95% CI 1.4, 4.7) in frail, and HR 1.8 (p=0.029, 95% CI 1.1, 3.2) in the pre-frail, compared to non-frail patients. (Figure) Conclusions: Using the Fried Frailty criteria to classify patients as frail, pre-frail and not-frail helped to identify patients with ambulatory HF at high risk for death, LVAD or transplant at 1 year. Assessment of frailty can improve triage for advanced HF therapies, inform our understanding of comparative outcomes with transplant, LVAD or continued medical therapy.