Frailty indices may predict mortality, other outcomes post-TAVR
ORLANDO, Fla. — The indices of frailty may be useful in predicting mortality and composite endpoints after transcatheter aortic valve replacement in elderly and potentially frail patients, according to data presented at the American College of Cardiology Scientific Session.
“Especially in the context of potentially expanding clinical indication, patient selection in TAVR continues to evolve. Superimposed on that is the notion of frailty,” Soroosh Kiani, MD, cardiovascular fellow at Emory University, said in a presentation. “Regardless of how it’s been defined, multiple prior studies have shown that there is an association between this frailty syndrome and poorer outcomes after TAVR. Interestingly, we've also seen that patients on the very extreme end of age spectrum do very well with TAVR in terms of mortality and quality of life may also suffer more complications as a result.”
According to Kiani, the researchers are unaware of any large-scale studies evaluating the role of frailty in TAVR or how it interacts with patients of different age groups.
To further explore that role, the researchers identified a cohort in the Society of Thoracic Surgery/ACC TVT registry of all patients undergoing elective first-time TAVR from 2011 to 2016.
A cohort of 56,500 patients was identified by the researchers, who linked their data to a CMS administrative claims database for robust mortality information.
The primary endpoints were all-cause mortality at 30 days and 1 year as well as a composite endpoint of readmission for HF exacerbation or mortality at 30 days and 1 year.
Secondary endpoints included MI incidence, bleeding as defined by the researchers, readmission for HF exacerbation and length of stay on the index admission after TAVR.
The researchers then evaluated for any interaction between those outcomes and frailty indices and patients at different deciles of age, starting at 65 to 74 and going up in increments of 10 years.
According to Kiani and colleagues, low albumin (< 3.5 g/dL), anemia (hemoglobin less than or equal to 12 g/dL for women or 13 g/dL for men), and slow walking speed on a 5-m gait test (< 0.83 m/sec), were all independently associated with both mortality and the composite endpoints at 30 days and 1 year, as well as increased bleeding, increased hospitalization rates for HF exacerbation and longer lengths of stay after TAVR.
Low albumin had the strongest association with mortality at 1 year after adjusting beyond the TVT risk model (HR = 1.52; 95% CI, 1.42-1.63).
The interactions between frailty and age for all endpoints were not significant, according to the researchers.
“We're happy to present the largest study of frailty and the relationship of frailty with outcomes in TAVR to date,” Kiani said. “These are a relatively easily attained clinical indices that are strong and relevant predictors of mortality and a useful bedside tool to help further risk-stratify these patients."– by Dave Quaile
Kiani, S. 1136M-03. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.
Disclosure: Kiani reports no relevant financial disclosures.