Clinical Frailty Scale and Outcomes After TAVR

Study Questions:

Can the semi-quantitative clinical frailty scale (CFS) be used to assess frailty among transcatheter aortic valve replacement (TAVR) patients?

Methods:

Data from the OCEAN (Optimized CathEter vAlvular iNtervention) Japanese multicenter registry were used for the present analysis. Data from adults who underwent TAVR between October 2013 and April 2016 were included. CFS ranges from 1 (fit) to 9 (terminally ill). Patients were grouped by CFS stages (CFS1-3; CFS4, CFS5, CFS6, and CFS≥7). The association between CFS score and other frailty measures was examined, including body mass index (BMI), serum albumin, gait speed, and mean hand grip (a measure of strength). Procedural outcomes and mortality were examined in relation to CFS scoring.

Results:

A total of 1,215 patients who underwent TAVR in nine centers were included in the present study. Distribution of the cohort by CFS groups was as follows: 38.0% were CFS1-3; 32.9% were CFS4; 15.1% were CFS5; 10.0% were CFS6; and 4.0% were CFS≥7%. CFS grade was associated with BMI, serum albumin, gait speed, and grip strength. Increased CFS grade was associated with cumulative 1-year mortality from 7.2% for CFS1-3 to 44.1% for CFS≥7. After adjusting for age, sex, BMI, smoking, log EuroSCORE, New York Heart Association class, B-type natriuretic peptide, creatinine, albumin, hemoglobin, left ventricular ejection fraction, and co-morbidities (diabetes mellitus, hypertension, peripheral arterial disease, coronary artery disease, stroke, coronary artery bypass grafting or percutaneous coronary intervention, lung disease, liver disease, cancer), each 1 category increase in CFS was significantly predictive of mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10-1.49).

Conclusions:

The authors concluded that the CFS was a useful marker for predicting late mortality in an elderly TAVR cohort.

Perspective:

These data highlight the importance of frailty on outcomes. Understanding components of frailty among TAVR patients can assist providers, patients, and their families to make informed decisions. These data also highlight the need to optimize health as we age to retard the development of frailty.

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Aortic Valve Stenosis, Biological Markers, Body Mass Index, Frail Elderly, Gait, Geriatrics, Hand Strength, Heart Valve Diseases, Mortality, Outcome Assessment (Health Care), Secondary Prevention, Serum Albumin, Terminally Ill, Transcatheter Aortic Valve Replacement


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