Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation

Sunita R. Jha, Malin K. Hannu, Keren Gore, Sungwon Chang, Phillip Newton, Kay Wilhelm, Christopher S. Hayward, Andrew Jabbour, Eugene Kotlyar, Anne Keogh, Kumud Dhital, Emily Granger, Paul Jansz, Phillip M. Spratt, Elyn Montgomery, Michelle Harkess, Peta Tunicliff, Patricia M Davidson, Peter S. Macdonald

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study was to identify whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty provides better outcome prediction in patients with advanced heart failure referred for heart transplantation (HT). Methods: Beginning in March 2013, all patients with advanced heart failure referred to our Transplant Unit have undergone a physical frailty assessment using the Fried frailty phenotype. Cognition was assessed with the Montreal Cognitive Assessment and depression with the Depression in Medical Illness questionnaire. We assessed the value of 4 composite frailty measures: physical frailty (PF ≥ 3 of 5 = frailty), "cognitive frailty" (CogF ≥ 3 of 6 = frail), "depressive frailty" (DepF ≥ 3 of 6 = frail), and "cognitive-depressive frailty" (ComF ≥ 3 of 7 = frail) in predicting outcomes. Results: Frailty was assessed in 156 patients (109 men, 47 women), aged 53 ± 13 years, and with a left ventricular ejection fraction of 27% ± 14%. Inclusion of cognitive impairment or depression in the definition of frailty increased the proportion classified as frail from 33% using PF to 42% using ComF. During follow-up, 28 patients died before ventricular assist device implantation or HT. Frailty was associated with significantly lower ventricular assist device- and HT-free survival, with CogF best capturing early mortality: 12-month survival for non-frail and frail cohorts was 81% ± 5% vs 58% ± 10% (p <0.02) using PF and 85% ± 5% vs 56% ± 9% (p <0.002) using CogF. Combining the Depression in Medical Illness score with PF or CogF did not strengthen the relationship between frailty and mortality. Conclusions: The addition of cognitive impairment to the assessment of PF strengthened its capacity to identify advanced heart failure patients referred for HT who are at high risk of early death.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2016

Fingerprint

Heart Transplantation
Heart Failure
Depression
Mortality
Heart-Assist Devices
Platelet Factor 3
Survival
Stroke Volume
Cognition
Cognitive Dysfunction
Transplants
Phenotype

Keywords

  • Cognitive impairment
  • Heart transplantation
  • Physical frailty
  • Survival
  • Ventricular assist device

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. / Jha, Sunita R.; Hannu, Malin K.; Gore, Keren; Chang, Sungwon; Newton, Phillip; Wilhelm, Kay; Hayward, Christopher S.; Jabbour, Andrew; Kotlyar, Eugene; Keogh, Anne; Dhital, Kumud; Granger, Emily; Jansz, Paul; Spratt, Phillip M.; Montgomery, Elyn; Harkess, Michelle; Tunicliff, Peta; Davidson, Patricia M; Macdonald, Peter S.

In: Journal of Heart and Lung Transplantation, 2016.

Research output: Contribution to journalArticle

Jha, SR, Hannu, MK, Gore, K, Chang, S, Newton, P, Wilhelm, K, Hayward, CS, Jabbour, A, Kotlyar, E, Keogh, A, Dhital, K, Granger, E, Jansz, P, Spratt, PM, Montgomery, E, Harkess, M, Tunicliff, P, Davidson, PM & Macdonald, PS 2016, 'Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation', Journal of Heart and Lung Transplantation. https://doi.org/10.1016/j.healun.2016.04.008
Jha, Sunita R. ; Hannu, Malin K. ; Gore, Keren ; Chang, Sungwon ; Newton, Phillip ; Wilhelm, Kay ; Hayward, Christopher S. ; Jabbour, Andrew ; Kotlyar, Eugene ; Keogh, Anne ; Dhital, Kumud ; Granger, Emily ; Jansz, Paul ; Spratt, Phillip M. ; Montgomery, Elyn ; Harkess, Michelle ; Tunicliff, Peta ; Davidson, Patricia M ; Macdonald, Peter S. / Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. In: Journal of Heart and Lung Transplantation. 2016.
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abstract = "Background: The aim of this study was to identify whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty provides better outcome prediction in patients with advanced heart failure referred for heart transplantation (HT). Methods: Beginning in March 2013, all patients with advanced heart failure referred to our Transplant Unit have undergone a physical frailty assessment using the Fried frailty phenotype. Cognition was assessed with the Montreal Cognitive Assessment and depression with the Depression in Medical Illness questionnaire. We assessed the value of 4 composite frailty measures: physical frailty (PF ≥ 3 of 5 = frailty), {"}cognitive frailty{"} (CogF ≥ 3 of 6 = frail), {"}depressive frailty{"} (DepF ≥ 3 of 6 = frail), and {"}cognitive-depressive frailty{"} (ComF ≥ 3 of 7 = frail) in predicting outcomes. Results: Frailty was assessed in 156 patients (109 men, 47 women), aged 53 ± 13 years, and with a left ventricular ejection fraction of 27{\%} ± 14{\%}. Inclusion of cognitive impairment or depression in the definition of frailty increased the proportion classified as frail from 33{\%} using PF to 42{\%} using ComF. During follow-up, 28 patients died before ventricular assist device implantation or HT. Frailty was associated with significantly lower ventricular assist device- and HT-free survival, with CogF best capturing early mortality: 12-month survival for non-frail and frail cohorts was 81{\%} ± 5{\%} vs 58{\%} ± 10{\%} (p <0.02) using PF and 85{\%} ± 5{\%} vs 56{\%} ± 9{\%} (p <0.002) using CogF. Combining the Depression in Medical Illness score with PF or CogF did not strengthen the relationship between frailty and mortality. Conclusions: The addition of cognitive impairment to the assessment of PF strengthened its capacity to identify advanced heart failure patients referred for HT who are at high risk of early death.",
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author = "Jha, {Sunita R.} and Hannu, {Malin K.} and Keren Gore and Sungwon Chang and Phillip Newton and Kay Wilhelm and Hayward, {Christopher S.} and Andrew Jabbour and Eugene Kotlyar and Anne Keogh and Kumud Dhital and Emily Granger and Paul Jansz and Spratt, {Phillip M.} and Elyn Montgomery and Michelle Harkess and Peta Tunicliff and Davidson, {Patricia M} and Macdonald, {Peter S.}",
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T1 - Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation

AU - Jha, Sunita R.

AU - Hannu, Malin K.

AU - Gore, Keren

AU - Chang, Sungwon

AU - Newton, Phillip

AU - Wilhelm, Kay

AU - Hayward, Christopher S.

AU - Jabbour, Andrew

AU - Kotlyar, Eugene

AU - Keogh, Anne

AU - Dhital, Kumud

AU - Granger, Emily

AU - Jansz, Paul

AU - Spratt, Phillip M.

AU - Montgomery, Elyn

AU - Harkess, Michelle

AU - Tunicliff, Peta

AU - Davidson, Patricia M

AU - Macdonald, Peter S.

PY - 2016

Y1 - 2016

N2 - Background: The aim of this study was to identify whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty provides better outcome prediction in patients with advanced heart failure referred for heart transplantation (HT). Methods: Beginning in March 2013, all patients with advanced heart failure referred to our Transplant Unit have undergone a physical frailty assessment using the Fried frailty phenotype. Cognition was assessed with the Montreal Cognitive Assessment and depression with the Depression in Medical Illness questionnaire. We assessed the value of 4 composite frailty measures: physical frailty (PF ≥ 3 of 5 = frailty), "cognitive frailty" (CogF ≥ 3 of 6 = frail), "depressive frailty" (DepF ≥ 3 of 6 = frail), and "cognitive-depressive frailty" (ComF ≥ 3 of 7 = frail) in predicting outcomes. Results: Frailty was assessed in 156 patients (109 men, 47 women), aged 53 ± 13 years, and with a left ventricular ejection fraction of 27% ± 14%. Inclusion of cognitive impairment or depression in the definition of frailty increased the proportion classified as frail from 33% using PF to 42% using ComF. During follow-up, 28 patients died before ventricular assist device implantation or HT. Frailty was associated with significantly lower ventricular assist device- and HT-free survival, with CogF best capturing early mortality: 12-month survival for non-frail and frail cohorts was 81% ± 5% vs 58% ± 10% (p <0.02) using PF and 85% ± 5% vs 56% ± 9% (p <0.002) using CogF. Combining the Depression in Medical Illness score with PF or CogF did not strengthen the relationship between frailty and mortality. Conclusions: The addition of cognitive impairment to the assessment of PF strengthened its capacity to identify advanced heart failure patients referred for HT who are at high risk of early death.

AB - Background: The aim of this study was to identify whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty provides better outcome prediction in patients with advanced heart failure referred for heart transplantation (HT). Methods: Beginning in March 2013, all patients with advanced heart failure referred to our Transplant Unit have undergone a physical frailty assessment using the Fried frailty phenotype. Cognition was assessed with the Montreal Cognitive Assessment and depression with the Depression in Medical Illness questionnaire. We assessed the value of 4 composite frailty measures: physical frailty (PF ≥ 3 of 5 = frailty), "cognitive frailty" (CogF ≥ 3 of 6 = frail), "depressive frailty" (DepF ≥ 3 of 6 = frail), and "cognitive-depressive frailty" (ComF ≥ 3 of 7 = frail) in predicting outcomes. Results: Frailty was assessed in 156 patients (109 men, 47 women), aged 53 ± 13 years, and with a left ventricular ejection fraction of 27% ± 14%. Inclusion of cognitive impairment or depression in the definition of frailty increased the proportion classified as frail from 33% using PF to 42% using ComF. During follow-up, 28 patients died before ventricular assist device implantation or HT. Frailty was associated with significantly lower ventricular assist device- and HT-free survival, with CogF best capturing early mortality: 12-month survival for non-frail and frail cohorts was 81% ± 5% vs 58% ± 10% (p <0.02) using PF and 85% ± 5% vs 56% ± 9% (p <0.002) using CogF. Combining the Depression in Medical Illness score with PF or CogF did not strengthen the relationship between frailty and mortality. Conclusions: The addition of cognitive impairment to the assessment of PF strengthened its capacity to identify advanced heart failure patients referred for HT who are at high risk of early death.

KW - Cognitive impairment

KW - Heart transplantation

KW - Physical frailty

KW - Survival

KW - Ventricular assist device

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