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Heart, Lung and Circulation

Frailty as a Dynamic Measure for the Assessment of Aortic Valve Intervention

Published:February 15, 2022DOI:https://doi.org/10.1016/j.hlc.2022.02.001
      The 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 [
      • Otto C.M.
      • Nishimura R.A.
      • Bonow R.O.
      • Carabello B.A.
      • Erwin III, J.P.
      • Gentile F.
      • et al.
      2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
      ]. The members of a “Heart Team” vary between institutions, but there is an increasing involvement of geriatricians reflecting the ageing population. Frailty is a clinical syndrome characterised by multi-system impairment that decreases physiological reserve and increases vulnerability to stress [
      • Coylewright M.
      • Mack M.J.
      • Holmes D.R.
      • O’Gara P.T.
      A call for an evidence-based approach to the Heart Team for patients with severe aortic stenosis.
      ,
      • Stewart R.
      Cardiovascular disease and frailty: what are the mechanistic links?.
      ]. However, there is no standardisation of frailty measurement and different frailty scoring systems tend to use various physical measures along with age and co-morbidities. A recent systematic review of 66,448 patients who underwent cardiac surgery showed that 37% of patients had undergone an objective test, such as walking velocity or the 6-minute walk test. The remaining 63% underwent a broad range of frailty scoring systems with the most common being the Fried/Modified Fried (25%) [
      • Lee J.A.
      • Yanagawa B.
      • An K.R.
      • Arora R.C.
      • Verma S.
      • Friedrich J.O.
      Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients.
      ]. Frailty has been demonstrated to increase the risk of almost all complications of cardiac surgery [
      • Sepehri A.
      • Beggs T.
      • Hassan A.
      • Rigatto C.
      • Shaw-Daigle C.
      • Tangri N.
      • et al.
      The impact of frailty on outcomes after cardiac surgery: A systematic review.
      ].

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      References

        • Otto C.M.
        • Nishimura R.A.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin III, J.P.
        • Gentile F.
        • et al.
        2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2021; 143: e72-e227
        • Coylewright M.
        • Mack M.J.
        • Holmes D.R.
        • O’Gara P.T.
        A call for an evidence-based approach to the Heart Team for patients with severe aortic stenosis.
        J Am Coll Cardiol. 2015; 65: 1472-1480
        • Stewart R.
        Cardiovascular disease and frailty: what are the mechanistic links?.
        Clin Chem. 2019; 65: 80-86
        • Lee J.A.
        • Yanagawa B.
        • An K.R.
        • Arora R.C.
        • Verma S.
        • Friedrich J.O.
        Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients.
        J Cardiothorac Surg. 2021; : 16
        • Sepehri A.
        • Beggs T.
        • Hassan A.
        • Rigatto C.
        • Shaw-Daigle C.
        • Tangri N.
        • et al.
        The impact of frailty on outcomes after cardiac surgery: A systematic review.
        J Thorac Cardiovasc Surg. 2014; 148: 3110-3117
        • Jones D.R.
        • Chew D.P.
        • Horsfall M.J.
        • Sinhal A.R.
        • Joseph M.X.
        • Baker R.A.
        • et al.
        Impact of surgical and transcatheter aortic valve replacement on Frailty Score.
        Heart Lung Circ. 2022; 31: 566-574

      Linked Article

      • Impact of Surgical and Transcatheter Aortic Valve Replacement on Frailty Score
        Heart, Lung and CirculationVol. 31Issue 4
        • Preview
          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.
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