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As the population ages, the number of older adults assessed for heart transplant candidacy is notably increasing. However, it is not clear how best to assess risk beyond chronological age for this population. Our study focuses on the use of a biopsychosocial, chart-based frailty assessment in comparison with physical frailty assessments to attempt to predict clinical outcomes for heart transplant patients. 175 patients undergoing heart transplant evaluation were eligible for this single center observational study. Assessments were performed on all patients aged 55 years or older as well as in selected younger patients with clinical concern for frailty raised by the treating team. We conducted four frailty assessments: Short Physical Performance Battery (SPPB), Fried Frailty Phenotype (FFP), a 20-item Frailty Index (FI20), and Frailty Risk Score (FRS). In this study, FFP was weakly correlated with FRS (p=0.001, r2=0.224) while SPPB did not correlate with FRS (p=0.066, R2=0.075). None of the frailty assessments correlated with age. Pre-transplant frailty measured by SPPB was associated with failure to undergo transplant (p=0.035), but not by FFP or FRS. FRS was associated with 6-month readmission after transplant (p=0.029) while SPPB and FFP were not. SPPB and FFP were associated with mortality (p=0.022, p=0.008 respectively) while FRS was not (Figure). Chart review-based frailty assessments show potential prognostic value for older heart transplant candidates. These frailty assessments may be less time-consuming, virtual alternatives to physical frailty assessments that must be done in-person. In addition, chart-review frailty assessments have different associations with clinical outcomes, such as mortality, compared with physical frailty assessments. Future work should incorporate these measures into prognostic models and consider interventions for patients identified as frail, such as prehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Frailty status affects outcomes after heart transplantation, but the optimal way to assess frailty prior to transplant remains unknown., Methods: This single-center, observational study assessed 44 heart transplant candidates for frailty using three methods. The Short Physical Performance Battery (SPPB) and Fried Frailty Phenotype (FFP) were used as two physical assessments of frailty. The Frailty Risk Score (FRS) was used as a chart-review based assessment measuring 20 different biopsychosocial and functional components, including biomarkers, depression, cognitive impairment, and sleep., Results: We determined the correlation between FRS, SPPB, and FFP and how each correlated with clinical outcomes. Of 44 participants, mean age was 60 years. FRS correlated with SPPB and FFP (P = .043, P < .001, respectively). Higher frailty as measured by SPPB and FRS was significantly associated with lack of achieving waitlist status (P = .022; P = .002) and not being transplanted (P = .026; P = .008). Higher frailty by SPPB and FFP was also associated with mortality (P = .010; P = .025)., Conclusion: SPPB and chart-review FRS showed potential for predicting waitlist and transplant status of heart transplant candidates, while SPPB and FFP were associated with mortality. Additional studies may serve to validate these observations., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)