Impairments identified by comprehensive geriatric assessment in potential candidates for left ventricular assist device and heart transplantation

Abstract

Background: The aim of this study was to assess the prevalence of frailty and other impairments in potential left ventricular assist device (LVAD) and heart transplantation (HTx) candidates by performing a preoperative comprehensive geriatric assessment (CGA) and reviewing the treatment recommendations resulting from the CGA.

Methods and results: This cross-sectional study included 73 patients aged ≥40 years who received a CGA as part of the patient selection procedure for LVAD and HTx. In every patient, a conclusion comprising frailty and other impairments was formulated based on the medical, mental, functional, and social domains and recommendations were made. The mean age was 58 years (range 40-71) and 70 % were male. In 97 % of patients, at least one impairment was identified by the CGA. The most common impairments were polypharmacy, high morbidity burden, reduced renal function, osteopenia, depression, poor quality of life, reduced functionality, (risk of) malnutrition, reduced grip strength and high caregiver burden. A small proportion of the potential LVAD and HTx candidates were frail (7 % according to Fried's frailty criteria, 6 % according to the Edmonton Frail Scale) and 39 % were pre-frail. The domains for which most impairments were found and the domains for which most treatment recommendations were given matched well, with the functional domain as the frontrunner.

Conclusion: This study showed that most of the potential candidates for LVAD or HTx have impairments on at least one domain of the CGA. Impairments and associated risks can contribute to the decision making process for candidacy for LVAD and HTx.

Keywords: Comprehensive geriatric assessment; Heart transplantation; Impairments; Left ventricular assist device; Screening.

Fig. 1

The distribution of impairments resulting from the comprehensive geriatric assessment across the different domains (medical, mental, functional and social). (i)ADL, (instrumental) activities of daily living; TUGT, timed up and go test. All impairments were classified according to the domain to which they relate (medical, mental, functional and social). Of the impairments, frailty was not subdivided into any of the domains because all domains together lead to frailty.

Fig. 2

The distribution of the treatment recommendations resulting from the comprehensive geriatric assessment across the different domains (medical, mental, functional and social). All treatment recommendations were classified according to the domain to which they relate (medical, mental, functional and social). The treatment recommendations related to the eligibility for LVAD/HTx and recommendations regarding education, patient counselling, shared decision making and advance care planning, were not assigned to one specific domain as all domains taken together result in whether a person is appropriate for the intervention and are input for an advance care planning (ACP) conversation. In ACP conversations, the healthcare professional discusses with the patient what goals of care fit with the patient's values, beliefs and health status. This way, appropriate care and treatment is determined for the short term and direction is given for appropriate care and treatment in future scenarios.