Objective
Frailty is common in the aortic stenosis (AS) population and impacts outcomes after
both transcatheter and surgical aortic valve replacement (TAVR and sAVR, respectively).
Frailty can significantly impact the decision regarding the suitability of a patient
for aortic valve intervention, with frail patients often excluded. Since many frailty
tools use indicators which may be influenced by AS itself, some of which are subjectively
symptom driven, we sought to determine the impact of intervention on frailty scores.
Methods
A prospective, observational cohort study included patients being assessed for aortic
valve (AV) intervention with either TAVR or sAVR due to severe aortic stenosis. Patients
were assessed for symptoms at baseline, and 1- and 6-months post intervention subjectively,
using the New York Heart Association (NYHA) class and the Kansas City Cardiomyopathy
Questionnaire (KCCQ), and objectively, using a 6-minute walk test (6MWT). These were
compared with frailty at baseline and final review using the Fried Frailty Scale (FFS).
Results and Conclusions
Sixty-six (66) patients completed pre- and post-intervention reviews. The mean FFS
score was significantly lower, indicating less frailty, at 6 months relative to pre
procedure (1.18 vs 1.73, p=0.002). This correlated with the change in symptoms (p<0.001).
Between intervention groups, the final mean FFS of both groups decreased significantly,
with TAVR to 1.33 (p=0.030) and sAVR to 0.8 (p=0.015). There was no difference in
the degree of improvement between interventions (p=0.517). Aortic valve intervention
improves frailty scores in both TAVR and sAVR treated patients.
Keywords
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Article info
Publication history
Published online: October 13, 2021
Accepted:
September 6,
2021
Received in revised form:
August 23,
2021
Received:
March 25,
2021
Footnotes
No clinical trials, grants, contracts or other forms of financial support were involved in this work apart from a Flinders University Research Scholarship.
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Frailty as a Dynamic Measure for the Assessment of Aortic Valve InterventionHeart, Lung and CirculationVol. 31Issue 4
- PreviewThe candidacy of patients for major cardiac interventions is based on assessment of their co-morbidities and physical status. As the population ages, older patients with significant medical problems present with potentially correctable cardiovascular conditions. The “Heart Team” approach with multidisciplinary discussions has become the standard of care in most institutions to identify patients who are suitable for intervention and are reflected in recent guidelines [1]. The members of a “Heart Team” vary between institutions, but there is an increasing involvement of geriatricians reflecting the ageing population.
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