Cognitive frailty and mortality among patients on the heart transplant waiting list: A prospective cohort study.
- 1Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP - Brazil.
Abstract
Frailty is an important prognostic factor in patients with heart failure and in transplant candidates, while cognitive impairment remains an under-recognized component that may further worsen clinical outcomes. This prospective study aimed to determine the prevalence of physical and cognitive frailty among heart transplant candidates and their association with mortality. Physical frailty was assessed using the Fried criteria; cognition was evaluated using the MoCA (cognitive screening) and WASI (general intellectual functioning); and depressive symptoms were measured using the BDI. Cognitive frailty was defined as the presence of ≥3 of 6 criteria in a modified Fried phenotype, which incorporated cognitive impairment as an additional domain. A total of 150 patients listed for heart transplantation within the previous 30 days were included at a tertiary center in Brazil. The study population was predominantly male (70%), with Chagas disease etiology (35%), and a mean age of 49.8 ± 10.4 years. Physical frailty was present in 78.7% of patients, cognitive frailty in 88.7% (MoCA) and 86.7% (WASI), and depressive symptoms in 44%, which were significantly associated with physical frailty (p = 0.021). During 1-year follow-up, 41.3% of patients died and 67.3% underwent transplantation. Physical frailty was associated with an increased risk of early mortality after listing (initial SHR = 5.47; p = 0.023), with significant attenuation of this effect over time (TVC SHR = 0.99; p = 0.008). A similar pattern was observed for cognitive frailty, measured by both MoCA (initial SHR = 1.61; p = 0.011; TVC SHR = 1.00; p = 0.011) and WASI (initial SHR = 1.57; p = 0.012; TVC SHR = 1.00; p = 0.007), indicating a reduction in its impact on mortality risk over time. However, after multivariable adjustment, neither physical nor cognitive frailty remained independently associated with overall mortality. Physical and cognitive frailty were highly prevalent among heart transplant candidates and showed a time-dependent association with early mortality risk. After adjustment for disease severity markers, this association lost significance, suggesting that frailty may, at least in part, reflect the underlying clinical status at the time of listing rather than acting as an independent prognostic factor. These findings also raise questions regarding the adequacy of the Fried phenotype as a frailty assessment tool in this specific population.
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BibTeX
@article{oliveira2026cognitive,
title = {{Cognitive frailty and mortality among patients on the heart transplant waiting list: A prospective cohort study.}},
author = {France Matos de Oliveira and Erika Tiemi Ikeda and Juliana Araújo Nascimento and Luis Fernando Bernal da Costa Seguro and Mônica Samuel Avila and Iascara Wozniak de Campos and Fábio Antônio Gaiotto and Miguel Morita Fernandes Silva and Victor Sarli Issa and Marcus Vinícius B Santos and Maria Ignez Zanetti Feltrim and Edimar Alcides Bocchi and Silvia Helena Lage and Fernando Bacal and Sandrigo Mangini and Fabiana Goulart Marcondes-Braga},
journal = {JHLT open},
year = {2026},
month = sep,
doi = {10.1016/j.jhlto.2026.100680},
url = {https://europepmc.org/article/MED/42898563},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Cognitive frailty and mortality among patients on the heart transplant waiting list: A prospective cohort study.
AU - France Matos de Oliveira
AU - Erika Tiemi Ikeda
AU - Juliana Araújo Nascimento
AU - Luis Fernando Bernal da Costa Seguro
AU - Mônica Samuel Avila
AU - Iascara Wozniak de Campos
AU - Fábio Antônio Gaiotto
AU - Miguel Morita Fernandes Silva
AU - Victor Sarli Issa
AU - Marcus Vinícius B Santos
AU - Maria Ignez Zanetti Feltrim
AU - Edimar Alcides Bocchi
AU - Silvia Helena Lage
AU - Fernando Bacal
AU - Sandrigo Mangini
AU - Fabiana Goulart Marcondes-Braga
PY - 2026
DA - 2026/09/12
JO - JHLT open
DO - 10.1016/j.jhlto.2026.100680
UR - https://europepmc.org/article/MED/42898563
AB - Frailty is an important prognostic factor in patients with heart failure and in transplant candidates, while cognitive impairment remains an under-recognized component that may further worsen clinical outcomes. This prospective study aimed to determine the prevalence of physical and cognitive frailty among heart transplant candidates and their association with mortality. Physical frailty was assessed using the Fried criteria; cognition was evaluated using the MoCA (cognitive screening) and WASI (general intellectual functioning); and depressive symptoms were measured using the BDI. Cognitive frailty was defined as the presence of ≥3 of 6 criteria in a modified Fried phenotype, which incorporated cognitive impairment as an additional domain. A total of 150 patients listed for heart transplantation within the previous 30 days were included at a tertiary center in Brazil. The study population was predominantly male (70%), with Chagas disease etiology (35%), and a mean age of 49.8 ± 10.4 years. Physical frailty was present in 78.7% of patients, cognitive frailty in 88.7% (MoCA) and 86.7% (WASI), and depressive symptoms in 44%, which were significantly associated with physical frailty (p = 0.021). During 1-year follow-up, 41.3% of patients died and 67.3% underwent transplantation. Physical frailty was associated with an increased risk of early mortality after listing (initial SHR = 5.47; p = 0.023), with significant attenuation of this effect over time (TVC SHR = 0.99; p = 0.008). A similar pattern was observed for cognitive frailty, measured by both MoCA (initial SHR = 1.61; p = 0.011; TVC SHR = 1.00; p = 0.011) and WASI (initial SHR = 1.57; p = 0.012; TVC SHR = 1.00; p = 0.007), indicating a reduction in its impact on mortality risk over time. However, after multivariable adjustment, neither physical nor cognitive frailty remained independently associated with overall mortality. Physical and cognitive frailty were highly prevalent among heart transplant candidates and showed a time-dependent association with early mortality risk. After adjustment for disease severity markers, this association lost significance, suggesting that frailty may, at least in part, reflect the underlying clinical status at the time of listing rather than acting as an independent prognostic factor. These findings also raise questions regarding the adequacy of the Fried phenotype as a frailty assessment tool in this specific population.
SN - 2950-1334
ER -