Author + information
- Received September 12, 2017
- Revision received November 6, 2017
- Accepted November 9, 2017
- Published online February 19, 2018.
- Andreas W. Schoenenberger, MDa,∗ (, )
- André Moser, PhDa,b,
- Dominic Bertschi, MDa,
- Peter Wenaweser, MDc,
- Stephan Windecker, MDc,
- Thierry Carrel, MDd,
- Andreas E. Stuck, MDa and
- Stefan Stortecky, MDc
- aDepartment of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- bInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- cDepartment of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
- dDepartment of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
- ↵∗Address for correspondence:
Dr. Andreas W. Schoenenberger, Department of Geriatrics, Inselspital, Bern University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland.
Objectives This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores.
Background European System for Cardiac Operative Risk Evaluation (EuroSCORE) or Society of Thoracic Surgeons (STS) score have not been evaluated in combined models with frailty for mortality prediction after transcatheter aortic valve replacement (TAVR).
Methods This prospective cohort comprised 330 consecutive TAVR patients ≥70 years of age. Conventional scores and a frailty index (based on assessment of cognition, mobility, nutrition, and activities of daily living) were evaluated to predict 1-year all-cause mortality using Cox proportional hazards regression (providing hazard ratios [HRs] with confidence intervals [CIs]) and measures of test performance (providing likelihood ratio [LR] chi-square test statistic and C-statistic [CS]).
Results All risk scores were predictive of the outcome (EuroSCORE, HR: 1.90 [95% CI: 1.45 to 2.48], LR chi-square test statistic 19.29, C-statistic 0.67; STS score, HR: 1.51 [95% CI: 1.21 to 1.88], LR chi-square test statistic 11.05, C-statistic 0.64; frailty index, HR: 3.29 [95% CI: 1.98 to 5.47], LR chi-square test statistic 22.28, C-statistic 0.66). A combination of the frailty index with either EuroSCORE (LR chi-square test statistic 38.27, C-statistic 0.72) or STS score (LR chi-square test statistic 28.71, C-statistic 0.68) improved mortality prediction. The frailty index accounted for 58.2% and 77.6% of the predictive information in the combined model with EuroSCORE and STS score, respectively. Net reclassification improvement and integrated discrimination improvement confirmed that the added frailty index improved risk prediction.
Conclusions This is the first study showing that the assessment of frailty significantly enhances prediction of 1-year mortality after TAVR in combined risk models with conventional risk scores and relevantly contributes to this improvement.
This study was supported by research grants from Bern University Hospital, Bern, Switzerland; and a grant of the Swiss National Science Foundation, Bern, Switzerland (SNF Grant 32003B_135807). Dr. Windecker has received institutional research grant support from Bracco, Boston Scientific, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Schoenenberger and Moser contributed equally to the manuscript.
- Received September 12, 2017.
- Revision received November 6, 2017.
- Accepted November 9, 2017.
- 2018 American College of Cardiology Foundation