Author + information
- Received May 3, 2012
- Revision received May 30, 2012
- Accepted June 7, 2012
- Published online September 1, 2012.
- Philip Green, MD⁎,
- Abigail E. Woglom, RN†,
- Philippe Genereux, MD⁎,
- Benoit Daneault, MD⁎,
- Jean-Michel Paradis, MD⁎,
- Susan Schnell, ACNP-C‡,
- Marian Hawkey, RN⁎,
- Mathew S. Maurer, MD⁎,
- Ajay J. Kirtane, MD⁎,
- Susheel Kodali, MD⁎,
- Jeffrey W. Moses, MD⁎,
- Martin B. Leon, MD⁎,
- Craig R. Smith, MD⁎,† and
- Mathew Williams, MD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Mathew Williams, Columbia University Medical Center-New York Presbyterian Hospital, 177 Fort Washington Avenue, Milstein Building, Room 7-435, New York, New York 10032
Objectives This study sought to evaluate the impact of frailty in older adults undergoing transcatheter aortic valve replacement (TAVR) for symptomatic aortic stenosis.
Background Frailty status impacts prognosis in older adults with heart disease; however, the impact of frailty on prognosis after TAVR is unknown.
Methods Gait speed, grip strength, serum albumin, and activities of daily living status were collected at baseline and used to derive a frailty score among patients who underwent TAVR procedures at a single large-volume institution. The cohort was dichotomized on the basis of median frailty score into frail and not frail groups. The impact of frailty on procedural outcomes (stroke, bleeding, vascular complications, acute kidney injury, and mortality at 30 days) and 1-year mortality was evaluated.
Results Frailty status was assessed in 159 subjects who underwent TAVR (age 86 ± 8 years, Society of Thoracic Surgery Risk Score 12 ± 4). Baseline frailty score was not associated with conventionally ascertained clinical variables or Society of Thoracic Surgery score. Although high frailty score was associated with a longer post-TAVR hospital stay when compared with lower frailty score (9 ± 6 days vs. 6 ± 5 days, respectively, p = 0.004), there were no significant crude associations between frailty status and procedural outcomes, suggesting adequacy of the standard selection process for identifying patients at risk for periprocedural complications after TAVR. Frailty status was independently associated with increased 1-year mortality (hazard ratio: 3.5, 95% confidence interval: 1.4 to 8.5, p = 0.007) after TAVR.
Conclusions Frailty was not associated with increased periprocedural complications in patients selected as candidates to undergo TAVR but was associated with increased 1-year mortality after TAVR. Further studies will evaluate the independent value of this frailty composite in older adults with aortic stenosis.
Drs. Genereux, Daneault, Paradis, Kodali and Williams have consulted for Edwards Lifesciences. Dr. Kodali has served on the advisory board of TAVI-St. Jude's Medical and Thubrikar Aortic Valve. Drs. Smith and Moses received travel reimbursement from Edwards Lifesciences for their work on the PARTNER trial. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 3, 2012.
- Revision received May 30, 2012.
- Accepted June 7, 2012.
- American College of Cardiology Foundation