Frailty was a strong predictor of death and disability 1 year after transcatheter or surgical aortic valve replacement, according to findings published in the Journal of the American College of Cardiology.
Researchers also compared the predictive performance of frailty scales and found the Essential Frailty Toolset was best.
Jonathan Afilalo, MD, MSc, from the division of cardiology at Jewish General Hospital, McGill University, Montreal, and colleagues compared the predictive value of seven frailty scales in determining poor outcomes after TAVR and surgical AVR in the FRAILTY-AVR study.
The researchers compared the Fried, Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia and Essential Frailty Toolset scales in a cohort of 1,020 patients (mean age, 82 years) who underwent TAVR or surgical AVR between 2012 and 2016. The outcomes of interest were mortality and disability at 1 year.
Prevalence of frailty greatly varied by scale, ranging from a rate of 26% for Rockwood to 68% for Short Physical Performance Battery, and frailty was approximately twofold higher in those who underwent TAVR vs. those who underwent surgery, according to the researchers.
The Essential Frailty Toolset scale — which uses four components: lower-extremity weakness, cognitive impairment, anemia and hypoalbuminemia — was the strongest predictor of 1-year mortality (adjusted OR = 3.72; 95% CI, 2.54-5.45). It was associated with a C-statistic improvement of 0.071 (P < .001) and an integrated discrimination improvement of 0.067 (P < .001), Afilalo and colleagues wrote.
The Essential Frailty Toolset scale was also the strongest predictor of 1-year disability (adjusted OR = 2.13; 95% CI, 1.57-2.87) and 30-day mortality (adjusted OR = 3.29; 95% CI, 1.73-6.26), according to the researchers.
“The advantages of the [Essential Frailty Toolset], beyond its predictive value, are that it is quick to perform, it does not require specialized equipment, and, importantly, its components have high interobserver reliability and are actionable,” Afilalo and colleagues wrote. “[It] adds incremental predictive value to identify vulnerable older adults and is recommended for use in this setting.” – by Erik Swain
Afilalo reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.