Is Surgery Right for Frail Adults with Heart Failure?

Patients showed improvement after surgery for left-ventricular-assist-device (LVAD).
Older Man's Hands

Common practice, and recently published research, shows that surgeries can be risky for very old or frail adults including those with heart failure. However, frailty can be defined as weakness, low energy or decreased physical activity, all of which are symptoms of heart failure. To tease apart whether frail patients might actually have a treatable heart condition, researchers looked at whether implanting the left ventricular-assist device (LVAD) could reduce frailty and improve a patient’s quality of life. Jefferson researchers found that for some patients, it did, as early as three months after surgery.  

“Surgery can carry greater risks for older, frail individuals,” says cardiologist Gordon Reeves. “Importantly, this study shows that frailty is modifiable and can get better with interventions like the LVAD.” The results were published in the Journal of the American Geriatrics Society.

The LVAD is a pump that is surgically implanted into the left ventricle of the heart, supplying blood to the rest of the body. The researchers assessed patients on measures of frailty, quality of life, and cognition before and after performing LVAD surgery.

Dr. Reeves and colleagues found that in many patients, frailty decreased with LVAD surgery, and the patients reported feeling better and having a higher quality of life. However, about half of patients remained frail. Changes in frailty were also associated with quality of life measures, so that patients whose frailty did not improve, also did not see any improvements in quality of life. “We don’t have enough data from this trial to be able to say which patients would benefit from LVAD versus those who won’t,” says Dr. Reeves.

“Although these results show that the LVAD procedure can decrease measure of frailty in some patients, we know that it does not completely reverse it,” says Dr. Reeves. “There are also a number of interventions, such as physical therapy, and nutrition supplementation, that have shown promise in reducing frailty even further after LVAD surgery. This is an active area of research for us as well.”

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