The Impact of Frailty Status on Survival After Transcatheter Aortic Valve Replacement in Older Adults With Severe Aortic Stenosis
Open accessAbstract
Objectives This study sought to evaluate the impact of frailty in older adults undergoing transcatheter aortic valve replacement (TAVR) for symptomatic aortic stenosis.Background Frailty status impacts prognosis in older adults with heart disease; however, the impact of frailty on prognosis after TAVR is unknown.Methods Gait speed, grip strength, serum albumin, and activities of daily living status were collected at baseline and used to derive a frailty score among patients who underwent TAVR procedures at a single large-volume institution. The cohort was dichotomized on the basis of median frailty score into frail and not frail groups. The impact of frailty on procedural outcomes (stroke, bleeding, vascular complications, acute kidney injury, and mortality at 30 days) and 1-year mortality was evaluated.Results Frailty status was assessed in 159 subjects who underwent TAVR (age 86 ± 8 years, Society of Thoracic Surgery Risk Score 12 ± 4). Baseline frailty score was not associated with conventionally ascertained clinical variables or Society of Thoracic Surgery score. Although high frailty score was associated with a longer post-TAVR hospital stay when compared with lower frailty score (9 ± 6 days vs. 6 ± 5 days, respectively, p = 0.004), there were no significant crude associations between frailty status and procedural outcomes, suggesting adequacy of the standard selection process for identifying patients at risk for periprocedural complications after TAVR. Frailty status was independently associated with increased 1-year mortality (hazard ratio: 3.5, 95% confidence interval: 1.4 to 8.5, p = 0.007) after TAVR.Conclusions Frailty was not associated with increased periprocedural complications in patients selected as candidates to undergo TAVR but was associated with increased 1-year mortality after TAVR. Further studies will evaluate the independent value of this frailty composite in older adults with aortic stenosis.
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When poor health status is principally due to comorbidities and geriatric conditions, valve replacement might lead to unsatisfactory results in decreased survival and decline or lack of improvement in quality of life.
“When poor health status is principally due to comorbidities and geriatric conditions, valve replacement might lead to an unsatisfactory result both in terms decreased survival and a decline or lack of improvement in quality of life253–256.”
From Calcific aortic stenosis (2016) · cites this paper as [254]
The Results (Long-term survival; page unavailable) associate greater frailty with increased mortality after TAVR, supporting the survival concern for a geriatric condition. The paper did not assess quality-of-life decline or lack of improvement, and its comorbidity score was not associated with long-term mortality. It therefore does not support the full claim about poor health principally due to comorbidities and geriatric conditions. (LLM, conf=0.88)
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- Authors
- Green, P., Woglom, A. E., Genereux, P., Daneault, B., Paradis, J.-M., Schnell, S., Hawkey, M., Maurer, M. S., Kirtane, A. J., Kodali, S., Moses, J. W., Leon, M. B., Smith, C. R., & Williams, M.
- Affiliations
- Columbia University Irving Medical Center (US)
- Corresponding author
- Williams, Mathew
- ORCID
- Venue
- JACC: Cardiovascular Interventions
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 5
- Issue
- 9
- Pages
- 974-981
- ISSN
- 1876-7605 (ISSN-L)
- 1936-8798
- PMC
- PMC3717525
- OpenAlex
- W48844573
- Cited by
- 473
- References
- 36
- Citations by year
- 2026: 13 · 2025: 15 · 2024: 18 · 2023: 33 · 2022: 28 · 2021: 31 · 2020: 42 · 2019: 34 · 2018: 50 · 2017: 44 · 2016: 55 · 2015: 55 · 2014: 32 · 2013: 21 · 2012: 2
- FWCI
- 22.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC: Cardiovascular Interventions (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (L30 AG040558, K24AG036778)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Keywords
- frailty, transcatheter aortic valve implantation, severe aortic stenosis, older adults, long-term mortality, procedural complications, frailty score, walking speed, grip strength, serum albumin, activities of daily living, length of hospital stay, patient selection
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Aortic Valve Stenosis, Female, Gait, Cardiac Catheterization, Hemorrhage, Humans, Length of Stay, Male, New York City, Prospective Studies, Risk Factors, Serum Albumin, Severity of Illness Index, Time Factors, Vascular Diseases, Biomarkers, Geriatric Assessment, Comorbidity, Chi-Square Distribution, Proportional Hazards Models, Frail Elderly, Treatment Outcome, Hospital Mortality, Risk Assessment, Hand Strength, Heart Valve Prosthesis Implantation, Stroke, Kaplan-Meier Estimate, Acute Kidney Injury, Hospitals, High-Volume
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