Frailty Predicts Adverse Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR): From the National Inpatient Sample

Abugroun, Ashraf; Daoud, Hussein; Hallak, Osama; Abdel-Rahman, Manar E.; Klein, Lloyd W.

doi:10.1016/j.carrev.2021.02.004

Cited by 11 publications

(7 citation statements)

References 17 publications

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“…Given the complexity of the concept of frailty, there is currently no widely accepted consensus on of what constitutes frailty [ 11 ]. A variety of frailty indices have been introduced and applied to TAVR candidates, including frailty score [ 12 ]. multi-dimensional geriatric assessment [ 6 ], and an essential frailty toolset [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Baseline Six-Minute Walk Distance following Trans-Catheter Aortic Valve Replacement

Imamura

Narang

Ushijima

et al. 2023

JCM

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Background: The six-minute walk test is a practical tool for assessing functional capacity in patients with a variety of etiologies including pulmonary disease and heart failure. Six-minute walk distance (6MWD) is associated with mortality and morbidity in patients with a variety of comorbidities. We aimed to assess the prognostic impact of baseline 6MWD in patients with severe aortic stenosis undergoing trans-catheter aortic valve replacement (TAVR). Methods: Patients with severe aortic stenosis who underwent a six-minute walk test after index admission and underwent TAVR between 2015 and 2022 were included in this retrospective study. Patients were followed up for two years or until November 2022 following TAVR. The impact of baseline 6MWD on the primary composite outcome, defined as all-cause death and all-cause readmission during the 2-year observation period following index discharge, was assessed. Results: A total of 299 patients (median age 86 years old, 85 men) were included. They received a 6-min walk test prior to TAVR, underwent successful TAVR procedures, and were discharged alive. The median baseline 6MWD was 204 (143, 282) meters. Shorter baseline 6MWD was associated with higher cumulative incidence of the primary outcome with an adjusted hazard ratio of 0.76 (95% confidence interval 0.58–1.01, p = 0.055) with a cutoff 6MWD of 178 m during the 2-year observation period after index discharge. Conclusions: Overall, functional capacity was impaired in the elderly patients with severe aortic stenosis prior to TAVR. Patients with severe aortic stenosis having shorter baseline 6MWD tended to have higher rates of morbidity and mortality after successful TAVR. The clinical implication of aggressive cardiac rehabilitation to improve patients’ functional capacity and 6MWD-guided optimal patient selection remain the future concerns.

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Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Baseline Six-Minute Walk Distance following Trans-Catheter Aortic Valve Replacement

Imamura

Narang

Ushijima

et al. 2023

JCM

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“…Previous studies have investigated the relation of frailty on outcomes after TAVR. 5 , 23 , 24 , 25 Abugroun et al reported higher in‐hospital mortality and complications in a large sample of patients undergoing TAVR. 23 Moreover, Kundi et al found frailty to be a predictor of long‐term mortality.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 23 , 24 , 25 Abugroun et al reported higher in‐hospital mortality and complications in a large sample of patients undergoing TAVR. 23 Moreover, Kundi et al found frailty to be a predictor of long‐term mortality. 5 Finally, previous studies leveraging data from trials and trial registers found higher degrees of frailty to be associated with a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

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Frailty and Recurrent Hospitalization After Transcatheter Aortic Valve Replacement

Strange

Christensen²,

Sindet-Pedersen

et al. 2023

JAHA

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Background For frail patients with limited life expectancy, time in hospital following transcatheter aortic valve replacement is an important measure of quality of life; however, data remain scarce. Thus, we aimed to investigate frailty and its relation to time in hospital during the first year after transcatheter aortic valve replacement. Methods and Results From 2008 to 2020, all Danish patients who underwent transcatheter aortic valve replacement and were alive at discharge were included. Using the validated Hospital Frailty Risk Score, patients were categorized in the low, intermediate, and high frailty groups. Time in hospital and mortality up to 1 year are reported according to frailty groups. In total, 3437 (57.6%), 2277 (38.1%), and 257 (4.3%) were categorized in the low, intermediate, and high frailty groups, respectively. Median age was ≈81 years. Female sex and comorbidity burden were incrementally higher across frailty groups (low frailty: heart failure, 24.1%; stroke, 7.2%; and chronic kidney disease, 4.5%; versus high frailty: heart failure, 42.8%; stroke, 34.2%; and chronic kidney disease, 29.2%). In the low frailty group, 50.5% survived 1 year without a hospital admission, 10.8% were hospitalized >15 days, and 5.8% of patients died. By contrast, 26.1% of patients in the high frailty group survived 1 year without a hospital admission, 26.4% were hospitalized >15 days, and 15.6% died within 1 year. Differences persisted in models adjusted for sex, age, frailty, and comorbidity burden (excluding overlapping comorbidities). Conclusions Among patients undergoing transcatheter aortic valve replacement, frailty is strongly associated with time in hospital and mortality. Prevention strategies for frail patients to reduce hospitalization burden could be beneficial.

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“…It has been shown to predict adverse outcomes, including increased mortality and periprocedural complications in TAVR patients with reported OR of up to 1.38 (95% CI 1.35-1.42) for 30-days mortality and length of stay >10 days [6]. The correlation between poor HFRS and a higher risk of myocardial infarction, pericardial effusion, pacemaker requirement, severe hemorrhage, and vascular complications have also been documented with an OR of 1.06 to 1.14 after TAVR [7].…”

Section: Hospital Frailty Risk Score (Hfrs)mentioning

confidence: 98%

Frailty Evaluation Impact on TAVR Outcomes: A Mini-Review

Arcens

2024

AJBSR

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Frailty Predicts Adverse Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR): From the National Inpatient Sample

Cited by 11 publications

References 17 publications

Prognostic Impact of Baseline Six-Minute Walk Distance following Trans-Catheter Aortic Valve Replacement

Prognostic Impact of Baseline Six-Minute Walk Distance following Trans-Catheter Aortic Valve Replacement

Frailty and Recurrent Hospitalization After Transcatheter Aortic Valve Replacement

Frailty Evaluation Impact on TAVR Outcomes: A Mini-Review

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