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November 15, 2017

Jefferson study weighs pros, cons of surgery in frail heart failure patients

When doctors need to develop a treatment plan for older adults with heart failure, the option to pursue surgery is often complicated by whether the patient's constitution is too frail to withstand the effects of a taxing procedure.

New research out of the Sidney Kimmel Medical School at Thomas Jefferson University suggests proceeding with surgery could ultimately reduce the frailty of these individuals by resolving some of their underlying symptoms.

The research team, led by cardiologist Gordon Reeves, examined outcomes of left ventricle assist device (LVAD) surgery to determine whether it could improve measures of frailty often caused by heart failure, including weakness, low energy and decreased physical activity.

“Surgery can carry greater risks for older, frail individuals, but we wanted to test whether the LVAD could reverse frailty and improve quality of life in these higher risk patients,” said Reeves. 

“Importantly, this study shows that frailty is modifiable. It can get better with interventions like the LVAD.”

Reeves worked with colleagues at Columbia University to monitor 29 older, frail patients with advanced heart failure who were eligible to receive LVAD surgery. The procedure involves implanting a pump into the left ventricle to better supply blood to the rest of the body.

The majority of the patients, enrolled across five academic medical centers in the Greater Geriatric Cardiology Consortium, displayed significant improvement in frailty that lasted beyond six months after the operation. For some, the improvement came as early as three months.

Reeves stressed that the sample size in the trial study isn't sufficient to identify which patients are most likely to benefit from the surgical option.

“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,” Reeves said. 

“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.”

The study, published in the Journal of the American Geriatrics Society, was primarily funded by grants from the National Institutes of Aging.

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