Clinical Frailty as an Outcome Predictor After Transcatheter Aortic Valve Implantation.

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Citation: American Journal of Cardiology. 121(7):850-855, 2018 04 01.PMID: 29422352Institution: MedStar Heart & Vascular InstituteonForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Frailty/ep [Epidemiology] | *Mortality | *Transcatheter Aortic Valve Replacement | Activities of Daily Living | Aged | Aged, 80 and over | Aortic Valve Stenosis/ep [Epidemiology] | Balloon Valvuloplasty/sn [Statistics & Numerical Data] | Body Mass Index | Comorbidity | Female | Frailty/me [Metabolism] | Frailty/pp [Physiopathology] | Hand Strength | Humans | Logistic Models | Male | Multivariate Analysis | Odds Ratio | Pulmonary Disease, Chronic Obstructive/ep [Epidemiology] | Serum Albumin/me [Metabolism] | Treatment Outcome | Walk TestYear: 2018Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: Copyright (c) 2018 Elsevier Inc. All rights reserved.Society of Thoracic Surgeons (STS) score and frailty index are calculated routinely as part of transcatheter aortic valve implantation (TAVI) assessment to determine procedure risk. We aim to evaluate the incremental improvement of STS risk score using frailty status in predicting short- and long-term outcome after TAVI. Study population included 544 consecutive TAVI patients who completed full frailty assessment and STS score calculation before the procedure. Frailty is defined by the presence of any 3 of the following 5 criteria: algorithm-defined grip strength and 15-foot walking tests, body mass index<20kg/m<sup>2</sup>, Katz activity of daily living<=4/6, serum albumin<3.5g/dl. Multivariable logistic analysis of 30-day and 1-year mortality was performed using a logistic regression model that comprised the STS risk score model as a single variable. Based on frailty definition, 242 patients were frail and 302 patients were not. STS score was higher in the frail group than in the nonfrail group. Compared with STS risk score alone, frailty status was a significant predictor of 1-year mortality after TAVI procedure (odds ratio 1.0, 95% confidence interval [CI] 1.0 to 1.1, p=0.029 vs 2.75, 95% CI 1.55 to 4.87, p<0.001, respectively). Although the c-statistic of the 1-year STS risk prediction model only changed from 0.62 to 0.66 (p=0.08), the net reclassification improvement increased significantly to 52.8% after adding frailty to the prediction model (95% CI 0.28 to 0.77, p<0.0001). Frailty status is associated with higher mortality in TAVI cohort and incrementally improves the well-validated STS risk prediction model. Frailty assessment should continue to be part of the preprocedural assessment to further improve patient outcomes after TAVI.All authors: Alraies MC, Ben-Dor I, Bond E, Buchanan KD, Gai J, Pacha HM, Rogers T, Satler LF, Steinvil A, Torguson R, Waksman RFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2018-02-20
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29422352 Available 29422352

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Copyright (c) 2018 Elsevier Inc. All rights reserved.

Society of Thoracic Surgeons (STS) score and frailty index are calculated routinely as part of transcatheter aortic valve implantation (TAVI) assessment to determine procedure risk. We aim to evaluate the incremental improvement of STS risk score using frailty status in predicting short- and long-term outcome after TAVI. Study population included 544 consecutive TAVI patients who completed full frailty assessment and STS score calculation before the procedure. Frailty is defined by the presence of any 3 of the following 5 criteria: algorithm-defined grip strength and 15-foot walking tests, body mass index<20kg/m<sup>2</sup>, Katz activity of daily living<=4/6, serum albumin<3.5g/dl. Multivariable logistic analysis of 30-day and 1-year mortality was performed using a logistic regression model that comprised the STS risk score model as a single variable. Based on frailty definition, 242 patients were frail and 302 patients were not. STS score was higher in the frail group than in the nonfrail group. Compared with STS risk score alone, frailty status was a significant predictor of 1-year mortality after TAVI procedure (odds ratio 1.0, 95% confidence interval [CI] 1.0 to 1.1, p=0.029 vs 2.75, 95% CI 1.55 to 4.87, p<0.001, respectively). Although the c-statistic of the 1-year STS risk prediction model only changed from 0.62 to 0.66 (p=0.08), the net reclassification improvement increased significantly to 52.8% after adding frailty to the prediction model (95% CI 0.28 to 0.77, p<0.0001). Frailty status is associated with higher mortality in TAVI cohort and incrementally improves the well-validated STS risk prediction model. Frailty assessment should continue to be part of the preprocedural assessment to further improve patient outcomes after TAVI.

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