The Utilities of Family Frailty Score as a Novel Social Support Assessment Tool for Patients Undergoing Advanced Heart Failure Therapies

PurposeAdvanced heart failure (HF) therapies including heart transplantation (HT) and left ventricular assist device (LVAD) have been shown to improve survival and quality of life in end-stage HF patients. However, both therapies are medically complicated and demanding for the patients and often require substantial support for caregivers. The detailed assessment of social support prior to advanced HF therapies and the impact on post-HT/LVAD outcomes have not been reported.MethodsThis is a retrospective single center study enrolling consecutive patients who underwent HT or LVAD. The family frailty score (FFS) is calculated with 1 point assigned to each item based on their caregiver's characteristics and their relationship. The total point is between 0-9 with higher point indicating lower social support. Patients were categorized into HT and LVAD cohort for separate analyses. The median FFS was calculated for each group. Clinical outcomes were compared between below- and above-FFS groups in both HF and LVAD cohorts.ResultsTotal of 72 HT and 107 LVAD were included. In HT cohort, the above median FFS group (≥4) had higher 1-year survival (98% vs. 80%, p=0.04) and overall survival (94% vs. 59%, p=0.002, median follow-up period 1031 days). There was no difference in the incidence of treated 2R/3R rejection (26% vs. 40%, p=0.22). In LVAD cohort, the above median FFS group (≥3) had lower incidence of driveline infection (12% vs. 39%, p=0.002). There was no difference in 1-year survival (78% vs. 69%, p=0.34) and overall survival (59% vs. 48%, p=0.22, median follow-up period 656 days).ConclusionHigher FFS was associated with lower survival in HT recipients and higher incidence of driveline infection in LVAD recipients. The objective assessment of family/caregiver support using the family frailty score could help identify patients at higher risk for adverse clinical outcomes following advanced HF therapies. Advanced heart failure (HF) therapies including heart transplantation (HT) and left ventricular assist device (LVAD) have been shown to improve survival and quality of life in end-stage HF patients. However, both therapies are medically complicated and demanding for the patients and often require substantial support for caregivers. The detailed assessment of social support prior to advanced HF therapies and the impact on post-HT/LVAD outcomes have not been reported. This is a retrospective single center study enrolling consecutive patients who underwent HT or LVAD. The family frailty score (FFS) is calculated with 1 point assigned to each item based on their caregiver's characteristics and their relationship. The total point is between 0-9 with higher point indicating lower social support. Patients were categorized into HT and LVAD cohort for separate analyses. The median FFS was calculated for each group. Clinical outcomes were compared between below- and above-FFS groups in both HF and LVAD cohorts. Total of 72 HT and 107 LVAD were included. In HT cohort, the above median FFS group (≥4) had higher 1-year survival (98% vs. 80%, p=0.04) and overall survival (94% vs. 59%, p=0.002, median follow-up period 1031 days). There was no difference in the incidence of treated 2R/3R rejection (26% vs. 40%, p=0.22). In LVAD cohort, the above median FFS group (≥3) had lower incidence of driveline infection (12% vs. 39%, p=0.002). There was no difference in 1-year survival (78% vs. 69%, p=0.34) and overall survival (59% vs. 48%, p=0.22, median follow-up period 656 days). Higher FFS was associated with lower survival in HT recipients and higher incidence of driveline infection in LVAD recipients. The objective assessment of family/caregiver support using the family frailty score could help identify patients at higher risk for adverse clinical outcomes following advanced HF therapies.