Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Abstract

ObjectivesOur objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI.MethodsWe systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates.ResultsOf 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates.ConclusionsFrailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency.PROSPERO registration numberCRD42018090597.

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2

“…Frailty is a syndrome encompassing somatic, mental, psychological and social factors. The correct diagnosis of frailty is important as it may have implications on rehospitalisation and on mortality [ 264 ] Very widely used and preferred by the authors are the criteria of frailty according to Fried et al [ 265 ].…”

“…In aged and frail patients, significant improvements of the 6-min walk test and quality of life as measured by the MacNew Quality of Life Questionnaire, could be achieved by continuous aerobic exercise training at moderate intensity [ 264 , 266 , 267 , 268 , 269 , 270 , 271 , 272 , 273 , 274 ] A further increase in mobility, evaluated by the “Timed Up and Go Test”, can be a result of an additive dynamic strength training and physical exercise to improve coordinative functions [ 275 ]. Alternative forms of activity, such as Qi-Gong, are able to improve the sense of balance and reduce coordination problems significantly [ 276 ].…”

Personalized Preoperative Prediction of the Length of Hospital Stay after TAVI Using a Dedicated Decision Tree Algorithm

“…Other authors have also previously stressed the relevance of frailty as a significant predictor of outcomes after TAVI. Albumin was found to be the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional frailty measures [ 17 ]. Frailty is being commonly defined by the presence of any three of the following five criteria: algorithm-defined grip strength, 15-foot walking tests, body mass index < 20 kg/m 2 , Katz activity of daily living ≤ 4/6, and serum albumin < 3.5 g/dl [ 11 ].…”

“…Moreover, the use of the aforementioned predictors in cohorts of low-risk aortic stenosis patients treated with TAVI [ 31 ] should be the focus of further studies. In addition, the need for standardization of frailty measurements in clinical everyday practice to promote reporting consistency has been already vividly highlighted with a meta-analysis [ 17 ].…”

Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity

“…Consequently, the reported prevalence of frailty varies between 6% and 90%. [ 63 , 64 ] Determining which score to use, balancing a comprehensive frailty assessment with a busy clinical workload and determining what to do once frailty has been recognised are challenging. Below, we provide a summary of the main domains of frailty with validated thresholds for futility.…”