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Frailty Phenotype and Deficit Accumulation Frailty Index in Predicting Recovery After Transcatheter and Surgical Aortic Valve Replacement.
- Source :
-
The journals of gerontology. Series A, Biological sciences and medical sciences [J Gerontol A Biol Sci Med Sci] 2019 Jul 12; Vol. 74 (8), pp. 1249-1256. - Publication Year :
- 2019
-
Abstract
- Background: Frailty phenotype and deficit-accumulation frailty index (FI) are widely used measures of frailty. Their performance in predicting recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) has not been compared.<br />Methods: Patients undergoing SAVR (n = 91) or TAVR (n = 137) at an academic medical center were prospectively assessed for frailty phenotype and FI. Outcomes were death or poor recovery, defined as a decline in ability to perform 22 daily activities and New York Heart Association class 3 or 4 at 6 months after surgery. The predictive ability of frailty phenotype versus FI and their additive value to a traditional surgical risk model were evaluated using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement.<br />Results: TAVR patients had higher prevalence of phenotypic frailty (85% vs 38%, p < .001) and greater mean FI (0.37 vs 0.24, p < .001) than SAVR patients. In the overall cohort, FI had a higher C-statistic than frailty phenotype (0.74 vs 0.63, p = .01) for predicting death or poor recovery. Adding FI to the traditional model improved prediction (NRI, 26.4%, p = .02; integrated discrimination improvement, 7.7%, p < .001), while adding phenotypic frailty did not (NRI, 4.0%, p = .70; integrated discrimination improvement, 1.6%, p = .08). The additive value of FI was evident in TAVR patients (NRI, 42.8%, p < .01) but not in SAVR patients (NRI, 25.0%, p = .29). Phenotypic frailty did not add significantly in either TAVR (NRI, 6.8%, p = .26) or SAVR patients (NRI, 25.0%, p = .29).<br />Conclusions: Deficit-accumulation FI provides better prediction of death or poor recovery than frailty phenotype in older patients undergoing SAVR and TAVR.<br /> (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Subjects :
- Activities of Daily Living
Aged
Canada
Female
France
Humans
Male
Phenotype
Predictive Value of Tests
Prevalence
Prospective Studies
Risk Factors
United States
Aortic Valve Stenosis surgery
Frailty diagnosis
Geriatric Assessment
Heart Valve Prosthesis Implantation methods
Recovery of Function
Transcatheter Aortic Valve Replacement
Subjects
Details
- Language :
- English
- ISSN :
- 1758-535X
- Volume :
- 74
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The journals of gerontology. Series A, Biological sciences and medical sciences
- Publication Type :
- Academic Journal
- Accession number :
- 30165422
- Full Text :
- https://doi.org/10.1093/gerona/gly196