Commentary: Appropriate frailty measures should be incorporated into the development of accurate risk calculation models for evaluation of transcatheter aortic valve replacement candidates

The impact of frailty on adverse outcomes after transcatheter aortic valve replacement in older adults: A retrospective cohort study

“…This screening provides balanced information on the risks and benefits of TAVR and enables shared decision‐making 41 . Interventions such as family involvement, cotreatment with geriatrics, or a postoperative cardiac rehabilitation program can be useful in the prevention and postoperative treatment of geriatric complications like delirium or functional decline 40,42,43 . Through assessment of frailty, patients can be selected for prerehabilitation, as preoperative interventions to reduce frailty can be useful.…”

“…However, the TAVR guidelines contain very few recommendations regarding screening and treatment of frailty 4,39 . We recommend that frailty is included in conventional risk models for predicting mortality in cardiac surgery, such as The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) risk score 40 . We advise POS by the geriatrician to assess frailty status.…”

“…4,39 We recommend that frailty is included in conventional risk models for predicting mortality in cardiac surgery, such as The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) risk score. 40 We advise POS by the geriatrician to assess frailty status. This screening provides balanced information on the risks and benefits of TAVR and enables shared decision-making.…”

Risk scores: Tools with limitations that do not replace clinical judgment but only complement it

“…This assessment might be further improved by assessing mobility, cognitive status, and activities of daily living, the 3 other pillars of frailty, as previously stated out by several authors. 3 In addition to nutritional parameters, the following should be assessed: (1) mobility, such as the Afilalo 5-meter walk test 4 At the same time, joining the 4 aforementioned parameters, different frailty scales, such as the Edmonton Frailty Scale, Fried's scale, Rockwood's Frailty Index, Katz Index, or the Essential Frailty Toolset, should be applied. 5 By associating these scales to the to the classic risk scores in cardiac surgery, the risk/benefit equation can be dramatically improved.…”

“…This assessment might be further improved by assessing mobility, cognitive status, and activities of daily living, the 3 other pillars of frailty, as previously stated out by several authors. 3 …”