Assessment of Frailty in Transplant Candidates Flashcards
What is frailty?
-heightened vulnerability to stressors in the presence of low physiological reserve
-greater likelihood of disproportionate decompensation, negative events, functional decline, disability, and mortality when exposed to stressors
-takes person a longer time to recover, and they may not return to their baseline
Frailty and SOT (solid organ transplantation)
- Frailty is prevalent in adults with organ failure and tends to develop at
a younger age than the general population
** ppl with organ failure are more likely to experience frailty
-frailty increases with age, but is NOT synonymous with age
Post transplant outcomes in pre-frail vs frail patients:
Pre-frail:
-reserve diminishes at time of transplant can can get physiologic capacity back up to pre-transplant range
Frail:
-after transplant occurs, can never get back up to pre-transplant range of physiologic capacity
What are the most common adverse events related to frailty after patients receive organ transplants?
mortality
length of stay
transplant status (delisting)
waitlist mortality
What is an important role of PT for patients that are frail pre-transplant?
-helping to improve the amount of physiologic capacity –> reduce the frailty before TX happens
When a frail patient experiences a clinical insult or injury how does this differ from a nonfrail patient?
The frail patient is going into their physiologic reserve, whereas the non-frail patient is not.
Importance of identifying frailty in pts with HF:
FRAILTY LINKED TO:
-decompensation at lower thresholds
-inc. # hospitalizations
-increased rates of mortality
-predictive of falls and disability in heart failure pts
-negative linear relationship with health related quality of life
-52% of frail patients who underwent heart transplant survived 1 year after, compared to 100% in non-frail
Importance of Identifying Frailty in Patients with End Stage Lung Disease
FRAILTY LINKED WITH:
-increased disability, risk of death, increased risk of removal from wait list
-pre transplant frailty–> decreased post transplant survival
-frail subjects absolute risk of death within 1 year post transplant at 12.2%
ASSOCIATED WITH LOWER EXERCISE CAPACITY, DISABILITY, FALLS, HOSPITALIZATIONS, MORTALITY IN PTS WITH LUNG DISEASE
What is a common screening measure used to evaluate frailty risk in adults with heart failure and lung disease?
SPPB
-12 is highest score
HEART TX
-poorer SPPB scores–> higher mortality rates
LUNG TX
-1 point worsening of frailty based on SPPB score–> 20% increased risk of death
** increases in rehospitalization, decline in ADLs or death with a decline in SPPB post discharge in mixed cardiopulmonary acutely ill patients
MCID of SPPB
1
** has good responsiveness following rehab
LT-FS- lung transplant frailty scale:
- incorporates readily available clinical
data, added muscle mass, and added muscle mass and research-grade Biomarkers.
LT-FS models exhibited superior construct and predictive validity compared to
the SPPB and FFP
COMPONENTS:
-balance (SPPB)
-grip strength
-gait speed
-serum C reactive protein (inflammatory marker)
-gender/height/weight
-body composition (bioimpedence)
-biomarkers: IL1, IL6, TNF 1, growth/differentiation factor 15
What do survival and ICU stays look like in frail patients?
frail patients have lower survival and longer ICU stays
** among frail patients who survive the transplant–> frailty shown to be partly or completely reversible
-lung transplant itself reduced frailty
How to consider frailty risk clinically- what can we do?
-PT involved in pre heart and lung transplant evaluations
-re-eval over time following potential mitigating interventions
-selection meetings on weekly basis
ADDRESSING FRAILTY PRE-OP:
-for outpatient candidates:
–> rx to prehab option in HH, OP PT, pulmonary rehab, cardiac rehab
-for hospitalized pts:
–> IP physical therapy: adjust plan of care, considerations, patient education
