Author + information
- Received April 14, 2017
- Revision received June 5, 2017
- Accepted June 9, 2017
- Published online July 31, 2017.
- Jonathan Afilalo, MD, MSca,b,∗ (, )
- Sandra Lauck, PhDc,
- Dae H. Kim, MD, ScDd,
- Thierry Lefèvre, MDe,
- Nicolo Piazza, MD, PhDf,
- Kevin Lachapelle, MD, MScg,
- Giuseppe Martucci, MDf,
- Andre Lamy, MDh,
- Marino Labinaz, MDi,
- Mark D. Peterson, MD, PhDj,
- Rakesh C. Arora, MD, PhDk,
- Nicolas Noiseux, MD, MScl,
- Andrew Rassi, MDm,
- Igor F. Palacios, MDm,
- Philippe Généreux, MDn,
- Brian R. Lindman, MD, MSco,
- Anita W. Asgar, MD, MScp,
- Caroline A. Kim, MD, MS, MPHd,
- Amanda Trnkus, MScb,
- José A. Morais, MDq,
- Yves Langlois, MDr,
- Lawrence G. Rudski, MDa,
- Jean-Francois Morin, MDr,
- Jeffrey J. Popma, MDs,
- John G. Webb, MDc and
- Louis P. Perrault, MD, PhDt
- aDivision of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- bCentre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
- cCentre for Heart Valve Innovation, St. Paul’s Hospital, University of Vancouver, Vancouver, British Columbia, Canada
- dDivision of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
- eDivision of Cardiology, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
- fDivision of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
- gDivision of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- hDivision of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- iDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- jDivision of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- kDivision of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
- lDivision of Cardiac Surgery, Centre Hospitalier de l’Université de Montréal, Centre de Recherche du CHUM, Montreal, Quebec, Canada
- mDivision of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
- nDivision of Cardiology, Hôpital du Sacré-Coeur, Université de Montréal, Montreal, Quebec, Canada
- oDivision of Cardiology, Washington University School of Medicine, St. Louis, Missouri
- pDivision of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
- qDivision of Geriatric Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- rDivision of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- sDivision of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
- tDivision of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
- ↵∗Address for correspondence:
Dr. Jonathan Afilalo, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, E-222, Montreal, Quebec H3T 1E2, Canada.
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)
- aortic stenosis
- surgical aortic valve replacement
- transcatheter aortic valve replacement
The FRAILTY-AVR Study was funded by an Operating Grant from the Canadian Institutes for Health Research, a Clinical Research Scholars Award from the Fonds de Recherche du Québec en Santé, and a Research Fellowship Award from the Heart and Stroke Foundation of Canada. Dr. Lauck has served as a consultant to Edwards Lifesciences. Dr. D. Kim has served as a consultant to Alosa Health (nonprofit). Dr. Lefèvre has been a proctor for Edwards Lifesciences. Dr. Piazza has served as a consultant to Highlife, Microport, Boston Scientific, and Medtronic. Dr. Martucci has served as a consultant to Boston Scientific; and has been a proctor for Boston Scientific and Medtronic. Dr. Peterson has been a proctor for Edwards Lifesciences; and has served as a consultant for Edwards Lifesciences and LivaNova. Dr. Arora has received an unrestricted educational grant from Pfizer; has received honoraria from Mallickrodt Pharmaceutical; and has served on the advisory board for CSU-ALS North America. Dr. Palacios has served on the advisory boards of Medtronic, Abbott Vascular, Siemens, Abiomed, St. Jude Medical, and Ample Medical; and has been a proctor for St. Jude Medical and Edwards Lifesciences. Dr. Généreux has been a proctor for Edwards Lifesciences and Medtronic; and has received speaker fees from Medtronic. Dr. Lindman has served on the advisory board of Roche Diagnostics; has served as a consultant to Medtronic, Edwards Lifesciences, and Roche Diagnostics; and has received grant support from Roche Diagnostics and Edwards Lifesciences. Dr. Asgar has served as a consultant to Edwards Lifesciences and Medtronic. Dr. Morais has served on the advisory boards of Pfizer and Astellas. Dr. Rudski has minor stock holding outside of a managed portfolio in General Electric. Dr. Popma has received institutional grants from Medtronic and Abbott Vascular; and has served on the advisory boards of Boston Scientific and Abbott Vascular. Dr. Webb has served as a consultant to Edwards Lifesciences and Abbott Vascular. Dr. Perrault has served as a consultant to Somahlution; and has served on the advisory board of Clearflow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 14, 2017.
- Revision received June 5, 2017.
- Accepted June 9, 2017.
- 2017 American College of Cardiology Foundation