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J Am Coll Cardiol. 2017 Aug 8;70(6):689-700. doi: 10.1016/j.jacc.2017.06.024. Epub 2017 Jul 7.

Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study.

Author information

1
Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada. Electronic address: jonathan.afilalo@mcgill.ca.
2
Centre for Heart Valve Innovation, St. Paul's Hospital, University of Vancouver, Vancouver, British Columbia, Canada.
3
Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts.
4
Division of Cardiology, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France.
5
Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
6
Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
7
Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
8
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
9
Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
10
Division of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
11
Division of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du CHUM, Montreal, Quebec, Canada.
12
Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
13
Division of Cardiology, Hôpital du Sacré-Coeur, Université de Montréal, Montreal, Quebec, Canada.
14
Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri.
15
Division of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada.
16
Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada.
17
Division of Geriatric Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
18
Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
19
Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
20
Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts.
21
Division of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada.

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).

KEYWORDS:

aortic stenosis; disability; frailty; outcomes; surgical aortic valve replacement; survival; transcatheter aortic valve replacement

PMID:
28693934
DOI:
10.1016/j.jacc.2017.06.024
[Indexed for MEDLINE]
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