Assessing and managing frailty in advanced heart failure: An International Society for Heart and Lung Transplantation consensus statement

Quin E Denfeld; Sunita R Jha; Erik Fung; Tiny Jaarsma; Mathew S Maurer; Gordon R Reeves; Jonathan Afilalo; Nadine Beerli; Lavanya Bellumkonda; Sabina De Geest; Eiran Z Gorodeski; Emer Joyce; Jon Kobashigawa; Oliver Mauthner; Julee McDonagh; Izabella Uchmanowicz; Victoria Vaughan Dickson; JoAnn Lindenfeld; Peter Macdonald

doi:10.1016/j.healun.2023.09.013

Assessing and managing frailty in advanced heart failure: An International Society for Heart and Lung Transplantation consensus statement

J Heart Lung Transplant. 2023 Nov 29:S1053-2498(23)02028-4. doi: 10.1016/j.healun.2023.09.013. Online ahead of print.

Authors

Quin E Denfeld¹, Sunita R Jha², Erik Fung³, Tiny Jaarsma⁴, Mathew S Maurer⁵, Gordon R Reeves⁶, Jonathan Afilalo⁷, Nadine Beerli⁸, Lavanya Bellumkonda⁹, Sabina De Geest¹⁰, Eiran Z Gorodeski¹¹, Emer Joyce¹², Jon Kobashigawa¹³, Oliver Mauthner⁸, Julee McDonagh¹⁴, Izabella Uchmanowicz¹⁵, Victoria Vaughan Dickson¹⁶, JoAnn Lindenfeld¹⁷, Peter Macdonald¹⁸

Affiliations

¹ School of Nursing, Oregon Health & Science University, Portland, Oregon; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon. Electronic address: [email protected].
² Faculty of Medicine, University of Notre Dame, Sydney, Australia.
³ Division of Cardiology and Gerald Choa Cardiac Research Centre, Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Laboratory for Heart Failure + Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Hong Kong SAR, China; CUHK Medical Centre, Hong Kong and CUHK-Shenzhen School of Medicine, Shenzhen, China.
⁴ Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, Sweden; Department of Nursing Science, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands.
⁵ Columbia University Irving Medical Center, New York, New York.
⁶ Section on Cardiovascular Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
⁷ Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada.
⁸ Nursing Science, Department Public Health, University of Basel, Basel, Switzerland.
⁹ Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
¹⁰ Nursing Science, Department Public Health, University of Basel, Basel, Switzerland; Academic Center of Nursing and Midwifery, Department Public Health and Primary Care, KU Leuven, Belgium.
¹¹ Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
¹² Department of Cardiology, Mater University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
¹³ Cedars Sinai Medical Center, Los Angeles, California.
¹⁴ School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia; The Centre for Chronic and Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, New South Wales, Australia.
¹⁵ Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
¹⁶ School of Nursing, University of Connecticut, Storrs, Connecticut.
¹⁷ Vanderbilt Heart and Vascular Institute, Nashville, Tennessee.
¹⁸ St Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia; University of New South Wales, Sydney, Australia.

PMID: 38099896
DOI: 10.1016/j.healun.2023.09.013

Abstract

Frailty is increasingly recognized as a salient condition in patients with heart failure (HF) as previous studies have determined that frailty is highly prevalent and prognostically significant, particularly in those with advanced HF. Definitions of frailty have included a variety of domains, including physical performance, sarcopenia, disability, comorbidity, and cognitive and psychological impairments, many of which are common in advanced HF. Multiple groups have recently recommended incorporating frailty assessments into clinical practice and research studies, indicating the need to standardize the definition and measurement of frailty in advanced HF. Therefore, the purpose of this consensus statement is to provide an integrated perspective on the definition of frailty in advanced HF and to generate a consensus on how to assess and manage frailty. We convened a group of HF clinicians and researchers who have expertise in frailty and related geriatric conditions in HF, and we focused on the patient with advanced HF. Herein, we provide an overview of frailty and how it has been applied in advanced HF (including potential mechanisms), present a definition of frailty, generate suggested assessments of frailty, provide guidance to differentiate frailty and related terms, and describe the assessment and management in advanced HF, including with surgical and nonsurgical interventions. We conclude by outlining critical evidence gaps, areas for future research, and clinical implementation.

Keywords: frailty; heart failure; heart transplantation; mechanical circulatory support.

Publication types

Practice Guideline