Assessing and Managing Frailty in Advanced Heart Failure: An ISHLT Consensus Statement

Published 19 December 2023

Quin E. Denfeld, PhD, RN; Sunita R. Jha, PhD; Erik Fung, MD, PhD; Tiny Jaarsma, PhD, RN; Mathew S. Maurer, MD; Gordon R. Reeves, MD, MPT; Jonathan Afilalo, MD, MSc; Nadine Beerli, PhD; Lavanya Bellumkonda, MD; Sabina De Geest, PhD, RN; Eiran Z. Gorodeski, MD, MPH; Emer Joyce, MD, PhD; Jon Kobashigawa, MD; Oliver Mauthner, PhD; Julee McDonagh, PhD, RN; Izabella Uchmanowicz, PhD, RN; Victoria Vaughan Dickson, PhD, RN; JoAnn Lindenfeld, MD; Peter Macdonald, MD, PhD

J Heart Lung Transplant. Dec 2023.

• Advanced Heart Failure & Transplantation
• Consensus Document
• Nursing & Allied Health
• Publications & Journals
• Standards & Guidelines

Frailty is increasingly recognized as a salient condition in patients with heart failure (HF) as previous studies have determined that frailty is highly prevalent and prognostically significant, particularly in those with advanced HF. Definitions of frailty have included a variety of domains, including physical performance, sarcopenia, disability, comorbidity, and cognitive and psychological impairments, many of which are common in advanced HF. Multiple groups have recently recommended incorporating frailty assessments into clinical practice and research studies, indicating the need to standardize the definition and measurement of frailty in advanced HF.

The purpose of this consensus statement is to provide an integrated perspective on the definition of frailty in advanced HF and to generate a consensus on how to assess and manage frailty. ISHLT convened a group of HF clinicians and researchers who have expertise in frailty and related geriatric conditions in HF, who then focused on the patient with advanced HF. This document provides an overview of frailty and how it has been applied in advanced HF (including potential mechanisms), present a definition of frailty, generate suggested assessments of frailty, provide guidance to differentiate frailty and related terms, and describe the assessment and management in advanced HF, including with surgical and nonsurgical interventions. The authors conclude by outlining critical evidence gaps, areas for future research, and clinical implementation.

Read at JHLT

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