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The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience.
JACC Cardiovasc Interv. 2012 Sep; 5(9):974-81.JC

Abstract

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.

Authors+Show Affiliations

Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

22995885

Citation

Green, Philip, et al. "The Impact of Frailty Status On Survival After Transcatheter Aortic Valve Replacement in Older Adults With Severe Aortic Stenosis: a Single-center Experience." JACC. Cardiovascular Interventions, vol. 5, no. 9, 2012, pp. 974-81.
Green P, Woglom AE, Genereux P, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv. 2012;5(9):974-81.
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. (2012). The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC. Cardiovascular Interventions, 5(9), 974-81. https://doi.org/10.1016/j.jcin.2012.06.011
Green P, et al. The Impact of Frailty Status On Survival After Transcatheter Aortic Valve Replacement in Older Adults With Severe Aortic Stenosis: a Single-center Experience. JACC Cardiovasc Interv. 2012;5(9):974-81. PubMed PMID: 22995885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. AU - Green,Philip, AU - Woglom,Abigail E, AU - Genereux,Philippe, AU - Daneault,Benoit, AU - Paradis,Jean-Michel, AU - Schnell,Susan, AU - Hawkey,Marian, AU - Maurer,Mathew S, AU - Kirtane,Ajay J, AU - Kodali,Susheel, AU - Moses,Jeffrey W, AU - Leon,Martin B, AU - Smith,Craig R, AU - Williams,Mathew, PY - 2012/05/03/received PY - 2012/05/30/revised PY - 2012/06/07/accepted PY - 2012/9/22/entrez PY - 2012/9/22/pubmed PY - 2013/2/13/medline SP - 974 EP - 81 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 5 IS - 9 N2 - 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. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/22995885/The_impact_of_frailty_status_on_survival_after_transcatheter_aortic_valve_replacement_in_older_adults_with_severe_aortic_stenosis:_a_single_center_experience_ DB - PRIME DP - Unbound Medicine ER -