Heart Area, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Universidad Complutense, Madrid, Spain.
Am J Cardiol. 2023 Oct 15;205:28-34. doi: 10.1016/j.amjcard.2023.07.110. Epub 2023 Aug 13.
Assessment of frailty before heart transplant (HT) is recommended but is not standard in most HT protocols. Our objective was to evaluate frailty at inclusion in HT list and during follow-up and to assess the influence of baseline frailty on prognosis. A prospective multicenter study in all adults included in the nonurgent HT waiting list. Frailty was defined as Fried's frailty phenotype score ≥3. Mean follow-up was 25.9 ± 1.2 months. Of 99 patients (mean age 54.8 [43.1 to 62.5] years, 70 men [70.7%]), 28 were frail (28.3%). A total of 85 patients received HT after 0.5 ± 0.01 years. Waiting time was shorter in frail patients (0.6 years [0.3 to 0.8] vs 0.2 years [0.1 to 0.4], p = 0.001) because of an increase in priority. Baseline frailty was not associated with overall mortality, (hazard ratio 0.99 [95% confidence interval 0.41 to 2.37, p = 0.98]). A total of 16 transplant recipients died (18.8%). Of the remaining 69 HT recipients, 65 underwent frailty evaluation during follow-up. Patients without baseline frailty (n = 49) did not develop it after HT. Of 16 patients with baseline frailty, only 2 were still frail at the end of follow-up. Frailty is common in HT candidates but is reversible in most cases after HT and is not associated with post-transplant mortality. Our results suggest that frailty should not be considered an exclusion criterion for HT.
在进行心脏移植（HT）之前评估虚弱状态是推荐的，但在大多数 HT 方案中并非标准做法。我们的目的是评估纳入 HT 名单时和随访期间的虚弱状态，并评估基线虚弱状态对预后的影响。这是一项在所有纳入非紧急 HT 等待名单的成年人中进行的前瞻性多中心研究。虚弱状态定义为 Fried 虚弱表型评分≥3。平均随访时间为 25.9±1.2 个月。99 例患者（平均年龄 54.8[43.1 至 62.5]岁，70 例男性[70.7%]）中，28 例为虚弱状态（28.3%）。85 例患者在 0.5±0.01 年后接受 HT。虚弱患者的等待时间更短（0.6 年[0.3 至 0.8]与 0.2 年[0.1 至 0.4]，p=0.001），因为优先级提高。基线虚弱状态与总死亡率无关（风险比 0.99[95%置信区间 0.41 至 2.37，p=0.98]）。共有 16 例移植受者死亡（18.8%）。其余 69 例 HT 受者中，65 例在随访期间进行了虚弱评估。无基线虚弱状态的患者（n=49）在 HT 后未发生虚弱状态。在 16 例基线虚弱的患者中，只有 2 例在随访结束时仍为虚弱状态。虚弱状态在 HT 候选者中很常见，但在大多数情况下在 HT 后是可逆的，并且与移植后死亡率无关。我们的结果表明，虚弱状态不应被视为 HT 的排除标准。
