Abstract Body (Do not enter title and authors here): Introduction: Frailty portends worse outcomes for patients with advanced heart failure (HF) undergoing surgical advanced therapies. Falls are characteristic of frailty, but it is unknown to what degree a history of falls predicts post-operative risk. We hypothesized that a one-item falls survey routinely conducted by nurses in ambulatory settings is associated with worse outcomes in this population.
Methods: We conducted a retrospective cohort study of all patients undergoing heart transplantation or left ventricular assist device (LVAD) implantation at our institution between January 2020 and December 2023. Our primary exposure of interest was falls as assessed by a nursing questionnaire (“Have you had one or more falls within the last year?”) within 12 months or less prior to surgery. We investigated a variety of relevant clinical outcomes including hospital- and ICU-length of stay, duration of mechanical ventilator use, renal replacement therapy, and survival.
Results: The cohort consisted of 73 primarily middle-aged (median age 55 y) white (53%) men (75%), of whom 10 (14%) had a history of falls. Compared to those without falls, those with a history of falls had a higher prevalence of albuminemia (28% vs. 60%, P=0.043) and lower peak VO2 (11.3 ml/kg/min vs. 6.9 ml/kg/min, P=0.015). History of falls was associated with increased time on mechanical support (mean difference: +1.5 days, P=0.002), prolonged ICU stay (mean difference: +13 days, P=0.03), and prolonged hospital stay (mean difference: +17 days, P=0.03). Patients with a history of falls also had a higher rate of needing renal replacement therapy in the 90-days following surgery (adjusted HR 4.7, 95% CI 1.1-20, P=0.035). There were no differences in survival between the two groups.
Conclusions: Among patients with advanced HF undergoing heart transplantation or LVAD, a simple one-item nursing falls assessment is associated with markers of malnutrition and poor cardiovascular performance, and predicts clinically-relevant worse outcomes.