Background
Frailty status and patient-reported outcomes are especially pertinent in octogenarians
following transcatheter aortic valve implantation (TAVI) and surgical aortic valve
replacement (SAVR) to guide treatment decisions and promote patient-centred care.
Aim
We aimed to determine if frailty changed 6 months after aortic valve replacement (AVR)
in octogenarians, and to describe changes in self-rated health according to frailty
status in patients who underwent TAVI or SAVR.
Method
In a prospective cohort study, frailty and self-rated health were measured one day
prior to and 6 months after AVR. Frailty status was measured with the Study of Osteoporotic
Fracture index. Self-rated health was measured comprehensively with the disease-specific
Minnesota Living with Heart Failure Questionnaire, the generic Medical Outcomes Study
Short Form-12 questionnaire (SF-12), and two global questions from The World Health
Organization Quality of Life Instrument Abbreviated.
Results
Data were available for 143 consecutive patients (mean age 83±2.7 years, 57% women;
45% underwent TAVI). At baseline, 34% were robust, 27% prefrail, and 39% frail. Overall,
there was no change in the distribution of frailty status 6 months after baseline
(p=0.13). However, on an individual level 65 patients changed frailty status after
AVR (40 patients improved and 25 declined). Improvement in frailty status was common
in prefrail (33%; n=13) and frail patients (48%; n=27). Patients had improved self-rated
health after AVR, with significant differences between frailty states both at baseline
(SF-12 physical: 37.4 [robust], 33.1 [prefrail], 31.6 [frail], p=0.03); SF-12 mental:
51.9 [robust], 50.8 [prefrail], 44.5 [frail], p<0.001); and at the 6-month follow-up
(SF-12 physical: 45.4 [robust], 38.3 [prefrail], 32.1 [frail], p<0.001); SF-12 mental:
54.9 [robust], 49.6 [prefrail], 46.8 [frail], p=0.002).
Conclusions
Advanced treatment performed in a high-risk population allowed people to improve their
self-rated health. Although frailty is associated with poor self-rated health, frailty
status does not equal negative outcomes. The frail patients were those who improved
most in self-rated physical and mental health. They had the lowest baseline self-rated
health scores and had therefore the most to gain.
Keywords
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Article info
Publication history
Published online: March 10, 2021
Accepted:
October 22,
2020
Received in revised form:
September 23,
2020
Received:
July 24,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
ScienceDirect
Access this article on ScienceDirectLinked Article
- Frailty: A Dynamic Process in Aortic Stenosis?Heart, Lung and CirculationVol. 30Issue 8
- PreviewAortic stenosis (AS) is an important contributor to cardiovascular morbidity and mortality. Advanced age, congenital and infective processes contribute to degradation in the mechanical function of the valve [1]. The prevalence of AS increases with age and is the most common valvular disease in the ageing populations of the western world [2]. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) procedures are routinely offered to select AS patients; however, as the age and comorbidity of potential candidates continues to increase, appropriate risk stratification procedures are vital [3].
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