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.
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.
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.
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).
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.
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- 2017 ESC/EACTS guidelines for the management of valvular heart disease.Eur Heart J. 2017; 38: 2739-2791
- The evolving epidemiology of valvular aortic stenosis. the Tromso study.Heart. 2013; 99: 396-400
- Frailty in older adults: evidence for a phenotype.J Gerontol. 2001; 56A: M146-M156
- The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: a systematic review and meta-analysis.Eur Heart J Qual Care Clin Outcomes. 2017; 3: 123-132
- Prevalence of frailty in community- dwelling older persons: a systematic review.J Am Geriatr Soc. 2012; 60: 1487-1492
- Frailty assessment in the cardiovascular care of older adults.J Am Coll Cardiol. 2014; 63: 747-762
- Transitions between frailty states among community-living older persons.Arch Intern Med. 2006; 166: 418-423
- Frailty: implications for clinical practice and public health.Lancet. 2019; 394: 1365-1375
- Current Society of Thoracic Surgeons model reclassifies mortality risk in patients undergoing transcatheter aortic valve replacement.Circ Cardiovasc Interv. 2018; 11: e006664
- A novel geriatric assessment frailty score predicts 2-year mortality after transcatheter aortic valve implantation.Eur Heart J Qual Care Clin Outcomes. 2019; 5: 153-160
- Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR Study.J Am Coll Cardiol. 2017; 70: 689-700
- Functional status and quality of life after transcatheter aortic valve replacement: a systematic review.Ann Intern Med. 2014; 160: 243-254
- Changes in self-reported health and quality of life in octogenarian patients one month after transcatheter aortic valve implantation.Eur J Cardiovasc Nurs. 2017; 16: 7-987
- Health status after transcatheter aortic valve replacement in patients at extreme surgical risk: results from the CoreValve U.S. trial.JACC Cardiovasc Interv. 2015; 8: 315-323
- Predicting quality of life at 1 year after transcatheter aortic valve replacement in a real-world population.Circ Cardiovasc Qual Outcomes. 2018; 11: e004693
- Beyond adding years to life: health-related quality of life and functional outcomes in patients with severe aortic-valve stenosis at high surgical risk undergoing transcatheter aortic valve replacement.Curr Cardiol Rev. 2013; 9: 281-294
- A systematic review on the quality of life benefits after aortic valve replacement in the elderly.J Thorac Cardiovasc Surg. 2013; 145: 1173-1189
- Comparison of frequency, risk factors, and time course of postoperative delirium in octogenarians after transcatheter aortic valve implantation versus surgical aortic valve replacement.Am J Cardiol. 2015; 115: 802-809
- Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).Eur J Cardiothorac Surg. 2012; 42: 1-44
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- The logistic EuroSCORE.Eur Heart J. 2003; 24: 881-882
- “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women.Arch Intern Med. 2008; 168: 382-389
- A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233
- Determining important differences in scores. In: User’s Manual for the SF-36v2® Health Survey.2nd Edition. Quality Metric, Lincoln, NE2007
- Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo- controlled trial of pimobendan. Pimobendan Multicenter Research Group.Am Heart J. 1992; 124: 1017-1025
- The World Health Organisation`s WHOQOL - BREF quality of life assessment: psychometric properties and results of the international field trial A Report from the WHOQOL Group.Qual Life Res. 2004; 13: 299-310
- The relationship between intervening hospitalizations and transitions between frailty states.J Gerontol A Biol Sci Med Sci. 2011; 66: 1238-1243
- The impact of frailty on outcomes after cardiac surgery: a systematic review.J Thorac Cardiovasc Surg. 2014; 148: 3110-3117
- Frailty in elderly patients undergoing cardiac surgery increases hospital stay and 12-month readmission rate.Heart Lung Circ. 2020; 29: 1187-1194
- Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort.Eur Heart J. 2019; 40: 2231-2239
- Of Greek heroes, wiggling worms, mighty mice, and old body builders.J Gerontol A Biol Sci Med Sci. 2012; 67: 13-16
- Cardiac rehabilitation after transcatheter versus surgical prosthetic valve implantation for aortic stenosis in the elderly.Eur J Prev Cardiol. 2014; 21: 1341-1348
- Habitual physical activity in older adults undergoing TAVR: insights from the FRAILTY-AVR study.JACC Cardiovasc Interv. 2019; 12: 781-789
- Home-based versus centre-based cardiac rehabilitation.Cochrane Database Syst Rev. 2015; : CD007130
- Cardiac rehabilitation in older adults: is it just lifestyle?.Heart. 2020; 106: 1035-1037
- Inclusion of functional status measures in the risk adjustment of 30-day mortality after transcatheter aortic valve replacement: a report from the Society of Thoracic Surgeons/American College of Cardiology TVT Registry.JACC Cardiovasc Interv. 2018; 11: 581-589
- Prediction of poor outcome after transcatheter aortic valve replacement.J Am Coll Cardiol. 2016; 68: 1868-1877
- Association of patient-reported health status with long-term mortality after transcatheter aortic valve replacement: report from the STS/ACC TVT Registry.Circ Cardiovasc Interv. 2015; 8: e002875
- Patient-reported outcomes on the agenda in cardiovascular clinical practice.Eur J Cardiovasc Nurs. 2016; 15: 108-111
- Frequency and consequences of cognitive impairment in patients underwent transcatheter aortic valve implantation.Am J Cardiol. 2018; 122: 844-850
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
Published online: March 10, 2021
Accepted: October 22, 2020
Received in revised form: September 23, 2020
Received: July 24, 2020
© 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).
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- 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 . The prevalence of AS increases with age and is the most common valvular disease in the ageing populations of the western world . 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 .