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JoAnn Lindenfeld , MD Professor of Medicine Medical Director, Cardiac Transplant Program

Frailty and Quality-Adjusted Survival MEDAMACS AND INTERMACS. JoAnn Lindenfeld , MD Professor of Medicine Medical Director, Cardiac Transplant Program Associate Director, Center for Women’s Health Research University of Colorado. Frailty and Quality-Adjusted Survival MEDAMACS AND INTERMACS.

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JoAnn Lindenfeld , MD Professor of Medicine Medical Director, Cardiac Transplant Program

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  1. Frailty and Quality-Adjusted SurvivalMEDAMACS AND INTERMACS JoAnn Lindenfeld, MD Professor of Medicine Medical Director, Cardiac Transplant Program Associate Director, Center for Women’s Health Research University of Colorado

  2. Frailty and Quality-Adjusted SurvivalMEDAMACS AND INTERMACS What is frailty and how is it measured? Why is frailty important in LVAD patients? What do we know about frailty in LVAD patients? What about INTERMACS and MEDAMACS?

  3. Decline in physiological reserve Frailty Impaired Resistance to stressors Incomplete Recovery Increased morbidity and mortality Bergman H et al. J Gerontol A Biol S ci Med Sci 2007;62:731-7

  4. In fact frail patients are more likely to have a high BMI and central adiposity which masks “sarcopenia” Frailty is not always an “eyeball” impression Afilalo J et al. JACC 2010;56L1668-76. Gallagher d AJP Endo 2000;297:E366-75 Barzilay JL Arch Int MEd2007;167:635-41

  5. There are a Number of Ways to Measure Frailty Frailty phenotype1 Frailty index2 • Fried LP et a. J Gerontol Collab Res Group 2001;56:146-5 • Rockwood K et al. CMAJ 2005; 173:489-95

  6. Fried Frailty Phenotype A number of studies show that gait speed outperforms other criteria of frailty Fried LP et al. J Gerontol A. Biol Sci Med 2001;56: M146-56; Banden-Roche K et al J Gerontol a Biol Sci Med Sci 2006;61:262-66;Xue Q-L et al. J Gerontol A. BiolSci Med Sci 2008; 63:984-990

  7. INTERMACS and MEDAMACs15 foot gait speed Fifteen foot Gait Speed Test

  8. Frailty Index A frailty index will be able to be constructed with a number of other “health deficits” already measured in INTERMACS and MEDACMACs These “health deficits” include co-morbidities captured in INTERMACS and may also include signs, symptoms, nutritional indices. Rockwood K Mitinski A. BMC Geriatr 2008;8:24-34

  9. Frailty(Deficit) Index Predicts Mortality and Rehospitalizations (0.32 = frail, 0.23 to 0.32 = intermediate frail, <0.23 = not frail). Mortality and Rehospitalization Dunlay SM et al. J HLTx 2014;33:359-65

  10. Frailty (Handgrip) Predicts Mortality and Improves post LVAD n = 26 n = 31 n = 72 Chung CJ et al. J Card Failure 2014;20:310-15

  11. INTERMACS AND MEDAMACS Both Frailty Phenotype and Frailty Index are Available Frailty phenotype = Gait speed Frailty index = Can come up with multiple indices based on demographics, comorbidities, and labs

  12. MEDAMACS Baseline A and Baseline B (n = 53)

  13. INTERMACS AND MEDAMACS Both Frailty Phenotype and Frailty Index are Available How closely does gait speed (frailty phenotype) correlate with frailty indices? Does heart failure alone cause frailty? Is frailty predictive of heart failure progression? Do either frailty phenotype or index predict irreversibility of frailty? What outcomes do the frailty phenotype and indices predict—are they different? (eg respiratory failure, recovery to home) How closely does frailty correlate with quality of life?

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