Montgomery, E, Macdonald, PS, Newton, PJ, Jha, SR & Malouf, M 2020, 'Frailty in lung transplantation: a systematic review.', Expert Review of Respiratory Medicine, vol. 14, no. 2, pp. 219-227.View/Download from: Publisher's site
Introduction: Lung transplantation is an effective treatment for certain types of end-stage lung disease. Frailty is a complex clinical syndrome associated with decreased physiological reserve and an increased risk for suboptimal health outcomes.Area covered: This article reviews the current literature on frailty in lung transplantation, with an emphasis on frailty measures, prevalence and impact of frailty on morbidity and mortality prior to and following lung transplantation. Pubmed, EMBASE, CINAHL and Cochrane systematic review databases were searched to September 2019. The search included the MeSH terms 'frail elderly' or 'frailty' or 'sarcopenia' and 'lung disease' or 'lung transplantation'. Studies were included if: the population were undergoing evaluation for, listed for or received a lung transplant; frailty was prospectively assessed during lung transplant evaluation using systematically defined criteria; used human subjects and; published in English. The prevalence of frailty varied from 0% - 58%. The frailty phenotype and short physical performance battery were the most common measures. Frailty was associated with delisting and death pre-transplantation. Frailty was associated with an increased risk of early mortality post-lung transplantation.Expert opinion: Frailty is identified often in lung transplant candidates and is associated with adverse pre and post-transplantation outcomes. Further research is necessary to identify potential frailty interventions.
McDonagh, J, Salamonson, Y, Ferguson, C, Prichard, R, Jha, SR, Macdonald, PS, Davidson, PM & Newton, PJ 2020, 'Evaluating the convergent and discriminant validity of three versions of the frailty phenotype in heart failure: results from the FRAME-HF study.', European Journal of Cardiovascular Nursing, vol. 19, no. 1.View/Download from: Publisher's site
BACKGROUND:Frailty is an important predictive measure of mortality and rehospitalisation in people with heart failure. To date, there are no frailty instruments validated for use in people with heart failure. AIM:The aim of this study was to evaluate the convergent and discriminant validity of three versions of the frailty phenotype in those with heart failure. METHODS:A single site, prospective cohort study was undertaken among individuals with a confirmed diagnosis of heart failure. Frailty was assessed concurrently using three versions of the frailty phenotype: the original frailty phenotype and two modified versions; the Survey of Health, Ageing and Retirement in Europe frailty instrument (SHARE-FI) and the St Vincent's frailty instrument. Convergent and discriminant validity were assessed by reporting the correlations between each version and related heart failure subconstructs, and by evaluating the ability of each version to discriminate between normal and abnormal scores of other physical and psychosocial scales specific to heart failure-related subconstructs. RESULTS:The New York Heart Association classes were moderately correlated with the St Vincent's frailty instrument (r=0.47, P⩽0.001), SHARE-FI (r=0.42, P⩽0.001) and the frailty phenotype (r=0.42, P⩽0.001). The SHARE-FI and the St Vincent's frailty instrument were both able to discriminate consistently between normal and abnormal scores in three out of five of the physical and psychosocial subconstructs that were assessed. The SHARE-FI was also able to discriminate between inpatients and outpatients who were classified as frail. CONCLUSIONS:Both the SHARE-FI and the St Vincent's frailty instrument displayed good convergent and discriminant validity.
Montgomery, E, Macdonald, P, Newton, P, Chang, S, Jha, S, Hannu, M, Thomson, C, Malouf, M & Havryk, A 2020, 'Frailty as a Predictor of Mortality in Patients with Interstitial Lung Disease Referred for Transplantation', Transplantation, vol. 104, no. 4, pp. 864-872.View/Download from: Publisher's site
Montgomery, E, Macdonald, PS, Newton, PJ, Chang, S, Wilhelm, K, Jha, SR & Malouf, M 2020, 'Reversibility of Frailty after Lung Transplantation.', Journal of transplantation, vol. 2020.View/Download from: Publisher's site
Background:Frailty contributes to increased morbidity and mortality in patients referred for and undergoing lung transplantation (LTX). The study aim was to determine if frailty is reversible after LTX in those classified as frail at LTX evaluation. Methods:Consecutive LTX recipients were included. All patients underwent modified physical frailty assessment during LTX evaluation. For patients assessed as frail, frailty was reassessed on completion of the post-LTX rehabilitation program. Frailty was defined by the presence of ≥ 3 domains of the modified Fried Frailty Phenotype (mFFP). Results:We performed 166 lung transplants (frail patients, n = 27, 16%). Eighteen of the 27 frail patients have undergone frailty reassessment. Eight frail patients died, and one interstate recipient did not return for reassessment. In the 18 (66%) patients reassessed, there was an overall reduction in their frailty score post-LTX ((3.4 ± 0.6 to 1.0 ± 0.7), p < 0.001) with 17/18 (94%) no longer classified as frail. Improvements were seen in the following frailty domains: exhaustion, mobility, appetite, and activity. Handgrip strength did not improve posttransplant. Conclusions:Physical frailty was largely reversible following LTX, underscoring the importance of considering frailty a dynamic, not a fixed, entity. Further work is needed to identify those patients whose frailty is modifiable and establish specific interventions to improve frailty.
Pavasini, R, Serenelli, M, Celis-Morales, CA, Gray, SR, Izawa, KP, Watanabe, S, Colin-Ramirez, E, Castillo-Martínez, L, Izumiya, Y, Hanatani, S, Onoue, Y, Tsujita, K, Macdonald, PS, Jha, SR, Roger, VL, Manemann, SM, Sanchis, J, Ruiz, V, Bugani, G, Tonet, E, Ferrari, R, Volpato, S & Campo, G 2019, 'Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis.', Heart, vol. 105, no. 11, pp. 834-841.View/Download from: Publisher's site
OBJECTIVE: Grip strength is a well-characterised measure of weakness and of poor muscle performance, but there is a lack of consensus on its prognostic implications in terms of cardiac adverse events in patients with cardiac disorders. METHODS: Articles were searched in PubMed, Cochrane Library, BioMed Central and EMBASE. The main inclusion criteria were patients with cardiac disorders (ischaemic heart disease, heart failure (HF), cardiomyopathies, valvulopathies, arrhythmias); evaluation of grip strength by handheld dynamometer; and relation between grip strength and outcomes. The endpoints of the study were cardiac death, all-cause mortality, hospital admission for HF, cerebrovascular accident (CVA) and myocardial infarction (MI). Data of interest were retrieved from the articles and after contact with authors, and then pooled in an individual patient meta-analysis. Univariate and multivariate logistic regression was performed to define predictors of outcomes. RESULTS: Overall, 23 480 patients were included from 7 studies. The mean age was 62.3±6.9 years and 70% were male. The mean follow-up was 2.82±1.7 years. After multivariate analysis grip strength (difference of 5 kg, 5× kg) emerged as an independent predictor of cardiac death (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001), all-cause death (OR 0.87, 95% CI 0.85 to 0.89, p<0.0001) and hospital admission for HF (OR 0.88, 95% CI 0.84 to 0.92, p<0.0001). On the contrary, we did not find any relationship between grip strength and occurrence of MI or CVA. CONCLUSION: In patients with cardiac disorders, grip strength predicted cardiac death, all-cause death and hospital admission for HF. TRIAL REGISTRATION NUMBER: CRD42015025280.
Fung, E, Yang, X, Newton, PJ, Ferguson, C, Gastelurrutia, P, Lupón, J, Bayés-Genís, A, Jha, S & Macdonald, PS 2018, 'Letter by Fung et al Regarding Article, "Frailty and Clinical Outcomes in Heart Failure: A Systematic Review and Meta-analysis".', Journal of the American Medical Directors Association, vol. 19, no. 12, pp. 1143-1146.View/Download from: Publisher's site
McDonagh, J, Martin, L, Ferguson, C, Jha, S, Macdonald, P, Davidson, P & Newton, P 2018, 'Frailty assessment instruments in heart failure: a systematic review.', European Journal of Cardiovascular Nursing, vol. 17, no. 1.View/Download from: Publisher's site
Frailty is an independent predictor of mortality across many conditions. Reported rates of frailty in heart failure range from 15% to 74%. There are several instruments available to assess frailty; however, to date there has been no consensus on the most appropriate instrument for use in individuals with heart failure.
To identify how frailty is assessed in individuals with heart failure and to elucidate which domains of frailty are most frequently assessed.
Key electronic databases were searched (MEDLINE, COCHRANE Central and CINAHL) to identify studies that assessed frailty in individuals with heart failure using a formal frailty instrument.
Twenty studies published in 24 articles were included, for which a total of seven unique frailty instruments were identified. The most commonly used instrument was the Frailty Phenotype (n= 11), with the majority of studies using a modified version of the Frailty Phenotype (n= 8). The second most commonly used instrument identified was the Comprehensive Geriatric Assessment (n= 4).
There is an increasing interest in the assessment of frailty, but, to date, there is no frailty instrument validated specifically in the heart failure population.
Jha, SR, McDonagh, J, Prichard, R, Newton, PJ, Hickman, LD, Fung, E, Macdonald, PS & Ferguson, C 2018, '#Frailty: A snapshot Twitter report on frailty knowledge translation.', Australasian Journal on Ageing, vol. 37, no. 4, pp. 309-312.View/Download from: Publisher's site
The objectives of this short report are to: (i) explore #Frailty Twitter activity over a six-month period; and (ii) provide a snapshot Twitter content analysis of #Frailty usage.A mixed-method study was conducted to explore Twitter data related to frailty. The primary search term was #Frailty. Objective 1: data were collected using Symplur analytics, including variables for total number of tweets, unique tweeters (users) and total number of impressions. Objective 2: a retrospectively conducted snapshot content analysis of 1500 #Frailty tweets was performed using TweetReach™ .Over a six-month period (1 January 2017-31 June 2017), there was a total of 6545 #Frailty tweets, generating 14.8 million impressions across 3986 participants. Of the 1500 tweets (814 retweets; 202 replies; 484 original tweets), 56% were relevant to clinical frailty. The main contributors ('who') were as follows: the public (29%), researchers (25%), doctors (21%), organisations (18%) and other allied health professionals (7%). Tweet main message intention ('what') was public health/advocacy (41%), social communication (28%), research-based evidence/professional education (24%), professional opinion/case studies (15%) and general news/events (7%).Twitter is increasingly being used to communicate about frailty. It is important that thought leaders contribute to the conversation. There is potential to leverage Twitter to promote and disseminate frailty-related knowledge and research.
Mauthner, O, Claes, V, Deschodt, M, Jha, SR, Engberg, S, Macdonald, PS, Newton, PJ & De Geest, S 2017, 'Handle with care: A systematic review on frailty in usefulness in heart transplantation', TRANSPLANTATION REVIEWS, vol. 31, no. 3, pp. 218-224.View/Download from: Publisher's site
Jha, SR, Hannu, MK, Newton, PJ, Wilhelm, K, Hayward, CS, Jabbour, A, Kotlyar, E, Keogh, A, Dhital, K, Granger, E, Connellan, M, Jansz, P, Spratt, PM, Montgomery, E, Smith, A, Harkess, M, Tunicliff, P, Davidson, PM & Macdonald, PS 2017, 'Reversibility of Frailty After Bridge-to-Transplant Ventricular Assist Device Implantation or Heart Transplantation.', Transplantation direct, vol. 3, no. 7, pp. e167-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.
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: Publisher's site
Jha, SR, Hannu, MK, Chang, S, Montgomery, E, Harkess, M, Wilhelm, K, Hayward, CS, Jabbour, A, Spratt, PM, Newton, P, Davidson, PM & Macdonald, PS 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: 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 ρ < 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, 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, vol. 35, no. 9, pp. 1092-1100.View/Download from: Publisher's site
Jha, SR, 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.View/Download from: Publisher's site
Jha, S, Robson, D, Jansz, P, Spratt, P, Granger, E, Dhital, K, Connellan, M, Hayward, C, Muthiah, K, Jabbour, A, Kotlyar, E, Montgomery, E, Newton, P & Macdonald, P 2018, 'Reversibility of Fried's Physical Frailty Domains Post- Ventricular-Assist Device Implantation Among Patients with Advanced Heart Failure', International Society of Heart and Lung Transplantation 38th Annual Meeting, Nice, France.View/Download from: Publisher's site
Montgomery, E, Jha, S, Robson, D, Hayward, C, Newton, P, Jansz, P & Macdonald, P 2018, 'The Impact of Frailty on Post-Bridge-to-Transplant Ventricular Assist Device (VAD) Outcomes', International Society of Heart and Lung Transplantation 38th Annual Meeting, Nice, France, pp. S128-S129.View/Download from: Publisher's site
Montgomery, E, Macdonald, PS, Newton, P, Jha, S, Hannu, M, Thomson, C, Glanville, A, Havryk, A, Plit, M, Pearson, R, Benzimra, M, Harkess, M, Fritis-Lamora, R, DeTullio, N, Smith, A & Malouf, M 2018, 'Reversibility of frailty after lung transplantation', International Society of Heart and Lung Transplantation 38th Annual Meeting, Nice, France.View/Download from: Publisher's site
Montgomery, E, Macdonald, PS, Newton, PJ, Jha, SR, Hannu, M, Thomson, C, Glanville, A, Havryk, A, Plit, M, Pearson, R, Benzimra, M, Harkess, M & Malouf, M 2018, 'Frailty as a predictor of prognostic outcomes in patients with interstitial lung disease referred for lung transplantation', The Journal of Heart and Lung Transplantation, The International Society for Heart and Lung Transplantation 38th Annual Meeting, Elsevier, Nice, France, pp. S165-S165.View/Download from: Publisher's site
Offen, S, Jha, S, Connellan, M, Dhital, K, Granger, E, Harkess, M, Hayward, C, Jabbour, A, Jansz, P, Kotlyar, E, Montgomery, E, Muthiah, K, Newton, P, Smith, A, Spratt, P & Macdonald, P 2018, 'Frailty Predicts Mortality After Heart Transplantation', International Society of Heart and Lung Transplantation 38th Annual Meeting, Nice, France.View/Download from: Publisher's site
Jha, S, Hannu, M, Newton, P, Gore, K, Wilhelm, K, Hayward, C, Jabbour, A, Kotlyar, E, Keogh, A, Dhital, K, Granger, E, Jansz, P, Spratt, P, Montgomery, E, Harkess, M, Tunnicliff, P & Macdonald, P 2016, 'Reversibility of frailty in heart transplant listed patients', The Transplantation Society of Australia and New Zealand 34th Annual Scientific Meeting, Sydney, Australia.
Montgomery, E, Macdonald, P, Glanville, A, Malouf, M, Havryk, A, Plit, M, Benzimra, M, Rigby, A, Harkess, M, DeTullio, N, Smith, A, Hogan, A, Tunnicliff, P & Jha, S 2016, 'The Prevalence and Prognostic Significance of Frailty in Patients with Advanced Lung Disease Referred for Lung Transplantation', International Society of Heart and Lung Transplantation 35th Annual Meeting, Washington, USA.View/Download from: Publisher's site
Jha, S, Newton, P, Hannu, M, Wilhelm, K, Hayward, C, Kotlyar, E, Keogh, A, Dhital, K, Granger, E, Jansz, P, Spratt, P, Montgomery, E, Tunnicliff, P, Shaw, S & Macdonald, P 2015, 'Frailty as a Predictor of Outcomes in Heart Transplant-Eligible Patients With Advanced Heart Failure', International Society of Heart and Lung Transplantation 35th Annual Meeting, Nice, France.View/Download from: Publisher's site
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: 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.