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Frailty Assessment of TAVR and SAVR Patients
Study Questions:
Can frailty be measured in routine clinical practice in patients undergoing either a transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) procedure?
Methods:
The aim of this study was to assess the incremental predictive value of seven different frailty scales to predict poor outcomes after TAVR or SAVR. A prospective cohort of older adults undergoing these procedures was assembled from 14 centers in three countries. Data were collected between 2012 and 2016. The following frailty scales were compared: Fried, Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia, and the Essential Frailty Toolset (EFT). The primary outcomes of interest were all-cause mortality and disability 1 year after the procedure.
Results:
A total of 1,020 patients (median age, 82 years; 41% female) were included in the study. Of these, 646 had a TAVR and 374 had a SAVR. Depending on the scale used, the prevalence of frailty ranged from 26% to 68%. Frailty as measured by the EFT was the strongest predictor of death at 1 year (adjusted odds ratio [OR], 3.72; 95% confidence interval [CI], 2.54-5.45) with a C-statistic improvement of 0.071 (p < 0.001) and integrated discrimination improvement of 0.067 (p < 0.001). Moreover, the EFT was the strongest predictor of worsening disability at 1 year (adjusted OR, 2.13; 95% CI, 1.57-2.87) and death at 30 days (adjusted OR, 3.29; 95% CI, 1.73-6.26).
Conclusions:
The investigators concluded that frailty is a risk factor for death and disability following TAVR and SAVR. The EFT (a brief four-item scale encompassing lower-extremity weakness, cognitive impairment, anemia, and hypoalbuminemia) outperformed other frailty scales and is recommended for use in this setting.
Perspective:
These findings suggest that measurement of frailty may provide important information which providers and their patients can use in clinical decision making. Furthermore, such assessments may identify patients who would benefit from improved nutrition and physical therapy prior to the procedure. Clearly, further research is warranted.
Keywords: Anemia, Cardiac Surgical Procedures, Cognition Disorders, Frail Elderly, Geriatrics, Heart Valve Diseases, Heart Valve Prosthesis, Hypoalbuminemia, Primary Prevention, Risk Factors, Transcatheter Aortic Valve Replacement
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