An Initiative to Assess Frailty and Functional Status in Cardiac Transplant Candidates

The systematic evaluation of frailty is recommended as best practice in heart transplantation, but can be challenging to implement. This initiative assesses the implementation of frailty assessment for heart transplant candidates in the inpatient setting and describe frailty characteristics and content of prehabilitation plans in this population. All patients assessed for heart transplantation while hospitalized at our institution between 10/30/23 and 1/6/25 in whom PM&R was consulted were reviewed. Objective frailty measures, their correlation to listing for transplantation, and the content of prehabilitation plans were assessed. All 56 inpatient consults included completed frailty assessments performed by a multidisciplinary team and interpreted by a PM&R physician. Thirty two percent had mFFP scores in the frail range, and 25% had SPPBs in the frail range. No patients with SPPB in the frail range were listed for transplantation during the review period. All patients received prehabilitation plans with multiple recommendations in the areas of therapy/exercise, nutrition, and enhancing resilience. We conclude it is feasible to implement a sustainable, coordinated multidisciplinary frailty evaluation for hospitalized patients undergoing assessment for heart transplantation under PM&R physician leadership to inform the selection committee for risk stratification and created prehabilitation plans designed to improve patients' functional status.