Graduation Date

Fall 12-16-2022

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Dr. Bunny Pozehl

Second Advisor

Dr. Windy Alonso

Third Advisor

Dr. Leeza Struwe

Fourth Advisor

Dr. Alfred Fisher

Abstract

Frailty, the state of being vulnerable with susceptibility to decreased age-related physical reserve, is found in 56-79% of adults with end-stage HF receiving durable left ventricular assist device (dLVAD) therapy. Frailty increases risk of adverse events, including increased mortality in the dLVAD population, but less is known about depression, quality of life (QOL), cognition and frailty responsiveness. Therefore, we aimed to describe and compare frailty (5-Meter Walk Test, 5MWT), depression (Patient Health Questionnaire-9, PHQ-9), quality of life (EQ5D Visual Analog Scale, EQ-5D VAS) and cognition (Trailmaking B) from pre- to 12-months post-dLVAD We also compared demographics, clinical characteristics, and post-dLVAD outcomes across frailty trajectories at 12-months using retrospective data from an institutional database collected across nine years. Descriptive statistics, Wilcoxon Signed Rank test, Kruskal-
Wallis and Mann Whitney U analyses were used. The mean age of our sample at 12-months (n=46) was 65 ± 11 years, and predominately male (n=35, 76%). Over half of the sample were frail pre-dLVAD using the 5MWT (n=25, 54%). Frailty, depression and QOL all statistically improved from pre-dLVAD to 3-, 6-, and 12-months post-dLVAD (p<0.001). Four frailty trajectories were identified from pre-dLVAD to 12-months: Consistently Frail, Responsive, Decline, and Consistently Not Frail. With the exception of depression, QOL and length of stay, there were no differences across trajectories in post-dLVAD outcomes. Frailty, depression and QOL improved post-dLVAD based on pre-dLVAD status. A standardized multi-dimensional approach to frailty assessment is needed to continue exploring the effects and trajectory of frailty post-dLVAD.

Comments

2022 Copyright, the authors

Additional Files
Permission for Integral Conceptual Model of Fraity.pdf (171 kB)
Permission for Integral Conceptual Model of Frailty
approval for frailty Heart and Lung Manuscript.pdf (233 kB)
Approval for Manuscript use for Dissertation
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