Reversal of Frailty after LVAD Associated with Significant Reduction in Markers of Inflammation.
PURPOSE: Inflammation has been implicated in frailty seen in heart failure (HF), and macrophage migration inhibitory factor (MIF) has been associated with worse outcomes in HF. Assessment of frailty is key in determining eligibility for advanced therapies (AT). Most programs use a subjective assessment (SA), but the Modified Fried Frailty Index (mFFI) has been widely validated. We assessed MIF levels in patients referred for AT and the changes in mFFI and MIF after LVAD. Additionally, we compared SA to mFFI testing in patients referred for AT. METHODS: All patients referred for evaluation for AT underwent SA and mFFI assessments and blood testing for MIF. Three providers (Ps) independently assessed patients to be frail or not frail (SA). mFFI assigns a frailty point in each of five domains: weight loss, fatigue, activity, walk time, and strength. Patients are frail when scored ≥ 3. Patients who underwent LVAD were reevaluated for mFFI and MIF at 3 and 6 months. RESULTS: Over 18 months, 54 subjects (61±11 yrs) were studied, 11 underwent LVAD. Frail patients were older, and had lower albumin and Hb. SA significantly underestimated frailty compared to mFFI (3-23% vs. 60%, p<0.001) (Fig. 1A). Correlation between SA and mFFI was not strong (42-58% agreement, κ< 0.04). Most of the time, Ps were correct when designating a patient as frail and incorrect when designating a patient as not frail. Agreement between all 3 Ps was strong (71.4%, W= .34). Baseline MIF was elevated in AT patients (311±128 pg/mL). mFFI scores improved in all patients by 6 months after LVAD, such that they were significantly lower than baseline (2.9±1.4 vs. 0.9±0.9, p<0.003), with no patients being assessed as frail. In parallel, MIF significantly decreased after LVAD (Fig. 1B). CONCLUSION: SA significantly underestimates frailty as compared to mFFI. Both frailty scores and MIF improved after LVAD, suggesting reversibility of the frailty syndrome. Understanding frailty will be key to improving outcomes in advanced HF.