1. Quantitative increase in frailty is associated with diminished survival after transcatheter aortic valve replacement
- Author
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Marc Cohen, Bruce Haik, Mark J. Russo, Nicky Haik, Anne C. Mosenthal, Aurelie Merlo, Dhaval Chauhan, and Chunguang Chen
- Subjects
Male ,medicine.medical_specialty ,Activities of daily living ,Transcatheter aortic ,Frail Elderly ,medicine.medical_treatment ,Statistics as Topic ,Frailty Index ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Frailty Index score ,Single Center ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Valve replacement ,Internal medicine ,Activities of Daily Living ,medicine ,Humans ,030212 general & internal medicine ,Geriatric Assessment ,Aged ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Aortic Valve Stenosis ,Length of Stay ,Prognosis ,United States ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business - Abstract
The purpose of this study is to assess the impact of frailty index comprised of commonly used frailty metrics on outcomes following transcatheter aortic valve replacement (TAVR) outcomes, including mortality, length of stay, and discharge destination.Retrospective data collection was performed for 342 consecutive patients who underwent TAVR at a single center from May 15, 2012, to September 17, 2015. Frailty index score was calculated using 15-ft walk test, Katz activities of daily living, preoperative serum albumin, and dominant handgrip strength. Patients were given a frailty score from 0/4 to 4/4, with higher scores indicating greater levels of frailty. There were 27 patients (8%) in 0/4, 82 patients (24%) in 1/4, 129 patients (38%) in 2/4, 73 patients (21%) in 3/4, and 31 patients (9%) in 4/4 frailty group. Multivariate cox, logistic, and linear regression analyses showed that patients with frailty score of 3/4 or 4/4 had increased all-cause mortality (P = .015 and P.001) and were more likely to be discharged to an acute care facility (P = .083 and P = .001). 4/4 frail patients had increased post-operative length of stay (P = .014) when compared to less frail patients. Individual components of the frailty score were also independent predictors of all-cause mortality. Median survival in 4/4 frail patients was 7 months.Frailty index comprised of commonly used frailty metrics and its components are independent predictors of poor post-TAVR outcomes. There is a stepwise increase in mortality and post-TAVR length of stay with increasing frailty with dismal prognosis in extremely frail patients.
- Published
- 2016
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