Jha, S., McDonagh, J., Ferguson, C., Macdonald, P. & Newton, P. 2017, 'Frailty, not just about old people: Reply to Smith GD & Kydd A (2017) Getting care of older people right: the need for appropriate frailty assessment?', Journal of Clinical Nursing.View/Download from: UTS OPUS or Publisher's site
Jha, S.R., Hannu, M.K., Newton, P.J., Wilhelm, K., Hayward, C.S., Jabbour, A., Kotlyar, E., Keogh, A., Dhital, K., Granger, E., Connellan, M., Jansz, P., Spratt, P.M., Montgomery, E., Smith, A., Harkess, M., Tunicliff, P., Davidson, P.M. & Macdonald, P.S. 2017, 'Reversibility of Frailty After Bridge-to-Transplant Ventricular Assist Device Implantation or Heart Transplantation.', Transplantation direct, vol. 3, no. 7, p. e167.View/Download from: Publisher's site
We recently reported that frailty is independently predictive of increased mortality in patients with advanced heart failure referred for heart transplantation (HTx). The aim of this study was to assess the impact of frailty on short-term outcomes after bridge-to-transplant ventricular assist device (BTT-VAD) implantation and/or HTx and to determine if frailty is reversible after these procedures.Between August 2013 and August 2016, 100 of 126 consecutive patients underwent frailty assessment using Fried's Frailty Phenotype before surgical intervention: 40 (21 nonfrail, 19 frail) BTT-VAD and 77 (60 nonfrail, 17 frail) HTx-including 17 of the 40 BTT-VAD supported patients. Postprocedural survival, intubation time, intensive care unit, and hospital length of stay were compared between frail and nonfrail groups. Twenty-six frail patients were reassessed at 2 months or longer postintervention.Frail patients had lower survival (63 ± 10% vs 94 ± 3% at 1 year, P = 0.012) and experienced significantly longer intensive care unit (11 vs 5 days, P = 0.002) and hospital (49 vs 25 days, P = 0.003) length of stay after surgical intervention compared with nonfrail patients. Twelve of 13 frail patients improved their frailty score after VAD (4.0 ± 0.8 to 1.4 ± 1.1, P < 0.001) and 12 of 13 frail patients improved their frailty score after HTx (3.2 ± 0.4 to 0.9 ± 0.9, P < 0.001). Handgrip strength and depression improved postintervention. Only a slight improvement in cognitive function was seen postintervention.Frail patients with advanced heart failure experience increased mortality and morbidity after surgical intervention with BTT-VAD or HTx. Among those who survive frailty is partly or completely reversible underscoring the importance of considering this factor as a dynamic not fixed entity.
Mauthner, O., Claes, V., Deschodt, M., Jha, S.R., Engberg, S., Macdonald, P.S., Newton, P.J. & De Geest, S. 2017, 'Handle with care: A systematic review on frailty in cardiac care and its usefulness in heart transplantation.', Transplantation reviews (Orlando, Fla.), vol. 31, no. 3, pp. 218-224.View/Download from: Publisher's site
There is growing consensus that frailty, a state of vulnerability and a decline in functioning across multiple physiological body systems, is a valuable criterion to guide clinicians' risk prediction for poor outcomes in adult transplant candidates. In its 2016 listing criteria for heart transplantation the International Society for Heart Lung Transplantation recommends frailty assessment. We aimed to summarize the usefulness of frailty assessment in heart transplant candidates or recipients reported throughout the literature.We performed a systematic literature search in PubMed to identify papers reporting on frailty in transplantation, chronic heart failure, and ventricualr assist device implantation published over the last 10 years in English. Additionally, a hand search was conducted, including manually searching the reference lists and a citation search of relevant papers.Eleven primary research articles were included in this systematic review. Frailty is a risk factor for morbidity, hospitalization, and mortality in patients with advanced heart failure and individuals being considered for ventricualr assist device implantation. Of the patients being considered for transplantation, 33% are frail. The Frailty Phenotype by Fried is a particularly useful tool to quickly identify higher risk patients for adverse outcomes.A lack of standardization and limited evidence on frailty in transplantation limit its use as a definitive listing criterion. Future research efforts should focus on systematic integration of frailty measures in transplant practice.
McDonagh, J., Martin, L., Ferguson, C., Jha, S., Macdonald, P., Davidson, P. & Newton, P. 2017, 'Frailty assessment instruments in heart failure: a systematic review.', European Journal of Cardiovascular Nursing.View/Download from: UTS OPUS
Jha, S.R., Hannu, M.K., Chang, S., Montgomery, E., Harkess, M., Wilhelm, K., Hayward, C.S., Jabbour, A., Spratt, P.M., Newton, P., Davidson, P.M. & Macdonald, P.S. 2016, 'The Prevalence and Prognostic Significance of Frailty in Patients With Advanced Heart Failure Referred for Heart Transplantation.', Transplantation, vol. 100, no. 2, pp. 429-436.View/Download from: UTS OPUS or Publisher's site
Frailty is a clinically recognized syndrome of decreased physiological reserve. The heightened state of vulnerability in these patients confers a greater risk of adverse outcomes after even minor stressors. Our aim was to assess the prevalence and prognostic significance of the frailty phenotype in patients referred for heart transplantation.Consecutive patients referred or on the waiting list for heart transplantation from March 2013 underwent frailty assessment. Frailty was defined as a positive response to 3 or more of the following 5 components: weak grip strength, slowed walking speed, poor appetite, physical inactivity, and exhaustion. In addition, markers of disease severity were obtained, and all patients underwent cognitive (Montreal Cognitive Assessment) and depression (Depression in Medical Illness-10) screening.One hundred twenty patients (83 men:37 women; age, 53 ± 12 years, range, 16-73 years; left ventricular ejection fraction, 27 ± 14%) underwent frailty assessment. Thirty-nine of 120 patients (33%) were assessed as frail. Frailty was associated with New York Heart Association class IV heart failure, lower body mass index, elevated intracardiac filling pressures, lower cardiac index, anemia, hypoalbuminemia, hyperbilirubinemia, cognitive impairment, and depression (all < 0.05). Frailty was independent of age, sex, heart failure duration, left ventricular ejection fraction, or renal function. Frailty was an independent predictor of increased all-cause mortality: 1 year actuarial survival was 79 ± 5% in the nonfrail group compared with only 54 ± 9% for the frail group (P < 0.005).Frailty is prevalent among patients with advanced symptomatic heart failure referred for heart transplantation and is associated with increased mortality.
Jha, S.R., Hannu, M.K., Gore, K., Chang, S., Newton, P., Wilhelm, K., Hayward, C.S., Jabbour, A., Kotlyar, E., Keogh, A., Dhital, K., Granger, E., Jansz, P., Spratt, P.M., Montgomery, E., Harkess, M., Tunicliff, P., Davidson, P.M. & Macdonald, P.S. 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, vol. 35, no. 9, pp. 1092-1100.View/Download from: UTS OPUS or Publisher's site
Jha, S.R., Hannu, M., Newton, P., Wilhelm, K., Hayward, C., Jabbour, A., Kotlyar, E., Keogh, A., Dhital, K., Granger, E., Jansz, P., Spratt, P., Montgomery, E., Tunnicilff, P., Shaw, S. & MacDonald, P. 2015, 'Frailty as a Predictor of Outcomes in Heart Transplant-Eligible Patients With Advanced Heart Failure', JOURNAL OF HEART AND LUNG TRANSPLANTATION, vol. 34, no. 4, pp. S187-S188.
Ivynian, S., DiGiacomo, M., Jha, S., Crossley, C. & Newton, P. 2015, 'Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis', Heart Lung and Circulation, Cardiac Society of Australia and New Zealand, Elsevier, Melbourne, pp. 419-419.View/Download from: UTS OPUS or Publisher's site
Purpose: Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF.
Methods: Electronic databases searched were Medline, EMBASE and CINAHL. Studies were included if they were peer reviewed journal articles written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature.
Results: Much of the literature fit within the SRM, however this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed.
Implications: This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms.