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Medientyp:
E-Artikel
Titel:
Abstract 11352: Frailty in Pediatric Patients After Fontan Palliation is Associated with Impaired Quality of Life and Increased Hospitalizations
Beschreibung:
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<jats:bold>Introduction:</jats:bold>
Frailty is a clinical syndrome common in adults with chronic disease with resultant vulnerability to adverse health outcomes. There is little known about frailty in pediatric patients, including those with congenital heart disease. We hypothesized that the Fontan-palliated population have a high incidence of frailty.
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<jats:bold>Methods:</jats:bold>
This single center, prospective cohort study assessed frailty in patients (10-21 years old) after Fontan palliation. The five domains of frailty including slowness, weakness, exhaustion, shrinkage, and diminished physical activity were evaluated using a modified Fried frailty assessment comprised of validated pediatric tests. Providers also estimated their patient’s frailty. Quality of life (QOL) was assessed using PedsQL generic and cardiac modules. Standard descriptive statistics and univariate analyses identified risk factors associated with frailty.
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<jats:bold>Results:</jats:bold>
Of 54 participants (median age 15.3 years, 61% male), 18 (33%) were identified as frail while 26 (48%) were pre-frail. Patients frequently exhibited frailty in the domains of slowness (93%), weakness (41%), and diminished physical activity (39%). There was poor correlation between frailty scores and provider estimates of frailty (Kappa=0.11). Frail subjects were more likely to have lower PedsQL physical functioning scores (mean 62.8 ± SD 18.5 in Frail vs. 75.7 ± 16.0 in No/pre-Frail; p=0.01). Factors associated with frailty included protein losing enteropathy (p=0.03) and at least one hospitalization in the last year (p=0.047). Higher NYHA functional class (p=0.07) and > 4 clinic visits in the last year (p=0.08) trended toward an association with frailty.
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<jats:bold>Conclusion:</jats:bold>
Frailty was identified in 1/3 of pediatric patients after Fontan palliation with providers inconsistently recognizing it. Frail patients were more likely to have lower physical functioning, and higher healthcare utilization. These findings highlight the need for improved screening and support for an at-risk population that may not be readily apparent to providers. Additional studies are needed to better understand pediatric frailty, its reversibility, and whether it predicts vulnerability to adverse health outcomes as seen in adults.
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