Date Available

4-29-2021

Year of Publication

2021

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Candice Falls

Committee Member

Dr. Melissa Czarapata

Abstract

Abstract

Background: Frailty is common in many patients with advanced heart failure, including those who undergo left ventricular assist device (LVAD) implantation. Frailty has been associated with worse outcomes after other cardiac surgeries; however, little is known about the effect of frailty on postoperative outcomes after LVAD implant.

Purpose: The purpose of this project was to evaluate whether preoperative frailty [as determined by either short physical performance battery (SPPB) score ≤ 7/12 or 6-minute walk test (6-MWT) <200 >meters] is associated with poorer postoperative outcomes after LVAD implantation than non-frailty in adults with advanced heart failure.

Setting and Sample: This project was conducted at UK Chandler Hospital, a 945-bed, academic medical center. 120 adult advanced heart failure patients who had an LVAD implanted at UK Chandler Hospital between May 2015 and April 2020 were included in the sample.

Design: This project was a descriptive study employing retrospective and prospective chart review.

Methods: Data was collected through chart review from LVAD patients with documented preoperative 6-MWT and SPPB scores. Patients were considered frail if they had a 6-MWT≤ 7/12. Postoperative outcomes of hospital and ICU length of stay (LOS), time mechanically ventilated, placement of tracheostomy, discharge disposition, inpatient and one-year mortality, hospital readmissions at 30 and 90 days, and change in pre- and postoperative quality of life scores (QOL) were compared between frail and non-frail patients. Demographic and health data were collected and compared between frail and non-frail groups. Data was analyzed using SPSS software with the guidance of a university statistician.

Results: 41.1% of patients (n=46) had a SPPB score ≤ 7/12 and 53.3% of patients (n=64) had 6-MWT < 200 meters. When SPPB ≤ 7/12 was used to determine, frailty was associated with increased 1- year mortality (33.3 vs 15.6%, p=0.030), length of stay (LOS) (31 vs 18.5 days, p

Conclusion: Preoperative frailty is associated with worse postoperative outcomes, particularly, increased 1-year mortality, hospital and ICU LOS, time mechanically ventilated, tracheostomy placement, and discharge to an inpatient facility other than home after LVAD implant. Preoperative frailty assessment, should therefore, be completed on all patients prior to implantation, as the results can be used to help identify which patients may be less likely to benefit from this therapy or who may require more resources postoperatively. Based on this study’s analysis, SPPB is likely a better measure of frailty than 6-MWT in predicting negative outcomes.

Download

Share

COinS