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Background: Frailty assessment is recommended for patients with heart failure. Despite the availability of instruments to assess frailty, there are no clear recommendations regarding the optimal instrument to use in a heart failure context. This ambiguity combined with a lack of education and resources, often leads clinicians to rely on subjective estimates of frailty, such as 'the end-of-the-bed' or 'eyeball' test.Aim: To examine the association between clinician-estimated frailty and formal frailty assessment in adults with heart failure.Methods: Cross-sectional analysis of the FRAilty MEasurement in Heart Failure (FRAME-HF) study.Participants: (1) Adults aged ≥18 years in the outpatient heart failure clinic and cardiology ward; (2) and cardiovascular clinicians (nurses, physicians, and allied-health professionals). Following participant recruitment, cardiovascular clinicians were asked to rate the participant's frailty status based on their routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment were examined using a weighted Kappa statistic and Spearman's correlation coefficient.Results: A total of 75 patients and 39 clinicians were recruited, producing 194 paired frailty assessments. Mean age of the patients was 54 (±13) years. Correlation of pooled clinician-estimated frailty to formal frailty was fair (0.52, p=0.00). Correlation was highest between allied-health estimated frailty and formal frailty (0.70, p=0.00). Agreement between pooled clinician-estimated frailty and formal frailty was fair (0.33) and was highest between allied health-estimated frailty and formal frailty (0.45).Conclusion: Subjective clinician-estimated frailty is not a reliable replacement for formal frailty assessment in adults with heart failure, underscoring the need for assessment using a valid and reliable instrument. [ABSTRACT FROM AUTHOR]

Background: Up to 50% of heart transplant candidates require bridging with left ventricular assist devices (VAD). This study describes hospital activity and cost 1 year preceding and 1 year following VAD implant (pre-VAD) and for the year before transplant (pre-HTX). The sample comprises an Australian cohort and is the first study to investigate costs using both institutional and linked administrative data.Methods: Institutional activity was established for 77 consecutive patients actively listed for transplant between 2009 and 2012. Costs were sourced from the institution or Australian refined diagnosis groups (arDRGs) and the National Efficient Price for admissions to other public and private institutions. Data from 25/77 VAD recipients were analysed and compared with data from 52/77 pre-transplant patients. Total and per day at risk costs were assessed, as well as totals per resource.Results: Fifty per cent (50%) of the hospital costs in the pre-VAD year occurred during admission of VAD implant. Sixty-four per cent (64%) of costs in the pre-HTX and 38% in the pre-VAD period occurred outside the implanting centre. Costs in the year prior to VAD, $97,565 (IQR $86,907-$153,916), were significantly higher than costs accrued in the year prior to transplant, $40,250 ($13,493-$81,260), p < 0.0001. Once discharged, costs per day at risk for post-VAD patients approximated those from the pre-admission period, p = 0.16 and in the more clinically stable pre-HTX cohort, p = 0.08.Conclusion: Compared with the year prior, VAD implant stabilised hospital cost in patients discharged home. A high proportion of the hospital costs in the pre-implant year occur outside the implanting centre and should be considered in economic models assessing the impact of VAD implant. [ABSTRACT FROM AUTHOR]

Background: Widespread application of left ventricular assist devices (LVADs) in advanced heart failure, is limited by costs, and access to technical expertise. Hospitalisation drives both cost and inversely, quality of life - but cross institutional and pre-surgical inpatient length of stay data is missing in the Australian literature. We describe changes in hospitalisation rates, in the year before and after bridge to transplant LVAD therapy and preceding heart transplant (HTX).Methods: Hospitalisation, Australian refined diagnosis group (ArDRG), and clinical data were assessed for 77/100 consecutive patients listed for heart transplant between July of 2009 and June of 2012. Twenty-five of the patients required ventricular assist device (VAD) therapy whilst waitlisted. Hospitalisation was defined as the proportion of "days at risk" that were spent in hospital and included all public and private admissions identified in the year before and after VAD implant, or before HTX, in a linked administrative dataset of admissions across New South Wales.Results: Patients requiring VADs were clinically more unstable and spent proportionally more time in hospital than pre-HTX patients, (13% (IQR 10-20%) vs 4% (IQR1-10%), p<0.01). During the index admission, they spent 22days (IQR 10-33) in hospital before implantation, including 13 days in non-transplant centres (IQR 7-20). Following implantation, median inpatient stay was 31(IQR 26-70) - including rehabilitation in 8 of the 25 patients. The number of admissions per patient reduced in the year after VAD-implant to two (IQR1-3), from five pre-implant (IQR 3-7) p=0.002. This was similar to the pre-HTX group's three admissions (IQR1-6), p=0.33. Overall hospitalisation decreased in VAD patients beyond the first year - from 14% (IQR 10-20%) at 1-year to 0.5% (IQR 0-10%) at 2-years (p=0.002). A high percentage of hospitalisation prior to VAD (41%) and HTX (66%) occurred outside the transplant centre.Conclusions: A high proportion of activity in the pre-implant and transplant year occurs outside the implanting hospital with higher pre-implant hospitalisation in VAD patients reflecting clinical severity. Ventricular assist device implantation is significantly associated with reduced admissions, and hospitalisation once reconditioning has occurred. [ABSTRACT FROM AUTHOR]

Background New generation continuous-flow left ventricular assist devices (LVADs) utilise centrifugal pumps. Data concerning their effect on patient haemodynamics, ventricular function and tissue perfusion is limited. We aimed to document these parameters following HeartWare centrifugal continuous-flow LVAD (HVAD) implantation and to assess the impact of post-operative right heart failure (RHF). Methods We reviewed 53 consecutive patients (mean age 49.5 ± 14.1yrs) with HVAD implanted in the left ventricle, at St. Vincent's Hospital, Sydney, between January 2007 and August 2012. Available paired right heart catheterisation (n = 35) and echocardiography (n = 39) data was reviewed to assess response of invasive haemodynamics and ventricular function to LVAD support. Results A total of 28 patients (53%) were implanted from interim mechanical circulatory support. Seventeen patients (32%) required short-term post-implant veno-pulmonary artery extracorporeal membrane oxygenation. At 100 ± 61 days post-implant, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure decreased from 38.8 ± 7.7 to 22.9 ± 7.7 mmHg and 28.3 ± 6.4 to 13.4 ± 5.4 mmHg respectively (p < 0.001). LV end diastolic diameter decreased from 71.3 ± 12.7 to 61.1 ± 13.7 mm and LV end-systolic diameter from 62.7 ± 12.3 to 53.9 ± 14.4 mm (p < 0.001). Aortic regurgitation remained trivial. Serum sodium increased from 133.3 ± 5.7 to 139.3 ± 2.8mmol/L and creatinine decreased from 109.1 ± 42.5 to 74.3 ± 26.2 μmol/L (p < 0.001). Across the entire cohort, the six-month survival/transplant rate was significantly lower for RHF patients (72.2%, n = 18) compared to those without (96.9%, n = 35, p = 0.01). Conclusions HVAD support improves haemodynamics, LV dimensions and renal function. Following implantation with a centrifugal continuous-flow LVAD, RHF remains a significant risk with a tendency to worse outcomes in the short to medium term. [ABSTRACT FROM AUTHOR]