Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Mar 1;5(2):286-93.
doi: 10.1161/CIRCHEARTFAILURE.111.963215.

Frailty and the selection of patients for destination therapy left ventricular assist device

Kelsey M Flint  1 , Daniel D Matlock, Joann Lindenfeld, Larry A Allen
Affiliations
Review

Frailty and the selection of patients for destination therapy left ventricular assist device

Kelsey M Flint et al. Circ Heart Fail. .
No abstract available

PubMed Disclaimer

Figures

Figure
Figure
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.
See this image and copyright information in PMC

References

    1. Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–2251. - PubMed
    1. Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dem-bitsky W, Long JW, Ascheim DD, Tierney AR, Levitan RG, Watson JT, Meier P, Ronan NS, Shapiro PA, Lazar RM, Miller LW, Gupta L, Frazier OH, Desvigne-Nickens P, Oz MC, Poirier VL. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med. 2001;345:1435–1443. - PubMed
    1. Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, Ulisney KL, Baldwin JT, Young JB. Third INTERMACS Annual Report: the evolution of destination therapy in the United States. J Heart Lung Transplant. 2011;30:115–123. - PubMed
    1. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59:255–263. - PubMed
    1. Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med. 2010;26:275–286. - PubMed