Frailty in Older Adults Undergoing Aortic Valve Replacement Academic Article uri icon

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abstract

  • BACKGROUND: Frailty is a geriatric syndrome that diminishes the potential for functional recovery after a transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its integration in clinical practice has been limited by a lack of consensus on how to measure it. OBJECTIVES: This study sought to compare the incremental predictive value of 7 different frailty scales to predict poor outcomes following TAVR or SAVR. METHODS: A prospective cohort of older adults undergoing TAVR or SAVR was assembled at 14 centers in 3 countries from 2012 to 2016. The following frailty scales were compared: Fried, Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia, and the Essential Frailty Toolset (EFT). Outcomes of interest were all-cause mortality and disability 1 year after the procedure. RESULTS: The cohort was composed of 1,020 patients with a median age of 82 years. 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 to 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 to 2.87) and death at 30 days (adjusted OR: 3.29; 95% CI: 1.73 to 6.26). CONCLUSIONS: Frailty is a risk factor for death and disability following TAVR and SAVR. A brief 4-item scale encompassing lower-extremity weakness, cognitive impairment, anemia, and hypoalbuminemia outperformed other frailty scales and is recommended for use in this setting. (Frailty Assessment Before Cardiac Surgery & Transcatheter Interventions; NCT01845207).

authors

  • Afilalo, Jonathan
  • Lauck, Sandra
  • Kim, Dae H
  • Lefèvre, Thierry
  • Piazza, Nicolo
  • Lachapelle, Kevin
  • Martucci, Giuseppe
  • Lamy, Andre
  • Labinaz, Marino
  • Peterson, Mark D
  • Arora, Rakesh C
  • Noiseux, Nicolas
  • Rassi, Andrew
  • Palacios, Igor F
  • Généreux, Philippe
  • Lindman, Brian R
  • Asgar, Anita W
  • Kim, Caroline A
  • Trnkus, Amanda
  • Morais, José A
  • Langlois, Yves
  • Rudski, Lawrence G
  • Morin, Jean-Francois
  • Popma, Jeffrey J
  • Webb, John G
  • Perrault, Louis P

publication date

  • August 2017

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