Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study

Jonathan Afilalo, Sandra Lauck, Dae H. Kim, Thierry Lefèvre, Nicolo Piazza, Kevin Lachapelle, Giuseppe Martucci, Andre Lamy, Marino Labinaz, Mark D. Peterson, Rakesh C. Arora, Nicolas Noiseux, Andrew Rassi, Igor F. Palacios, Philippe Généreux, Brian R. Lindman, Anita W. Asgar, Caroline A. Kim, Amanda Trnkus, José A. MoraisYves Langlois, Lawrence G. Rudski, Jean Francois Morin, Jeffrey J. Popma, John G. Webb, Louis P. Perrault

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

Background Frailty is a geriatric syndrome that diminishes the potential for functional recovery after a transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its integration in clinical practice has been limited by a lack of consensus on how to measure it. Objectives This study sought to compare the incremental predictive value of 7 different frailty scales to predict poor outcomes following TAVR or SAVR. Methods A prospective cohort of older adults undergoing TAVR or SAVR was assembled at 14 centers in 3 countries from 2012 to 2016. The following frailty scales were compared: Fried, Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia, and the Essential Frailty Toolset (EFT). Outcomes of interest were all-cause mortality and disability 1 year after the procedure. Results The cohort was composed of 1,020 patients with a median age of 82 years. Depending on the scale used, the prevalence of frailty ranged from 26% to 68%. Frailty as measured by the EFT was the strongest predictor of death at 1 year (adjusted odds ratio [OR]: 3.72; 95% confidence interval [CI]: 2.54 to 5.45) with a C-statistic improvement of 0.071 (p < 0.001) and integrated discrimination improvement of 0.067 (p < 0.001). Moreover, the EFT was the strongest predictor of worsening disability at 1 year (adjusted OR: 2.13; 95% CI: 1.57 to 2.87) and death at 30 days (adjusted OR: 3.29; 95% CI: 1.73 to 6.26). Conclusions Frailty is a risk factor for death and disability following TAVR and SAVR. A brief 4-item scale encompassing lower-extremity weakness, cognitive impairment, anemia, and hypoalbuminemia outperformed other frailty scales and is recommended for use in this setting. (Frailty Assessment Before Cardiac Surgery & Transcatheter Interventions; NCT01845207)

Original languageEnglish (US)
Pages (from-to)689-700
Number of pages12
JournalJournal of the American College of Cardiology
Volume70
Issue number6
DOIs
StatePublished - Aug 8 2017
Externally publishedYes

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Aortic Valve
Surgical Instruments
Odds Ratio
Confidence Intervals
Hypoalbuminemia
Geriatrics
Thoracic Surgery
Anemia
Lower Extremity
Consensus
Mortality
Transcatheter Aortic Valve Replacement

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Afilalo, J., Lauck, S., Kim, D. H., Lefèvre, T., Piazza, N., Lachapelle, K., ... Perrault, L. P. (2017). Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study. Journal of the American College of Cardiology, 70(6), 689-700. https://doi.org/10.1016/j.jacc.2017.06.024
Afilalo, Jonathan ; Lauck, Sandra ; Kim, Dae H. ; Lefèvre, Thierry ; Piazza, Nicolo ; Lachapelle, Kevin ; Martucci, Giuseppe ; Lamy, Andre ; Labinaz, Marino ; Peterson, Mark D. ; Arora, Rakesh C. ; Noiseux, Nicolas ; Rassi, Andrew ; Palacios, Igor F. ; Généreux, Philippe ; Lindman, Brian R. ; Asgar, Anita W. ; Kim, Caroline A. ; Trnkus, Amanda ; Morais, José A. ; Langlois, Yves ; Rudski, Lawrence G. ; Morin, Jean Francois ; Popma, Jeffrey J. ; Webb, John G. ; Perrault, Louis P. / Frailty in Older Adults Undergoing Aortic Valve Replacement : The FRAILTY-AVR Study. In: Journal of the American College of Cardiology. 2017 ; Vol. 70, No. 6. pp. 689-700.
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abstract = "Background Frailty is a geriatric syndrome that diminishes the potential for functional recovery after a transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its integration in clinical practice has been limited by a lack of consensus on how to measure it. Objectives This study sought to compare the incremental predictive value of 7 different frailty scales to predict poor outcomes following TAVR or SAVR. Methods A prospective cohort of older adults undergoing TAVR or SAVR was assembled at 14 centers in 3 countries from 2012 to 2016. The following frailty scales were compared: Fried, Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia, and the Essential Frailty Toolset (EFT). Outcomes of interest were all-cause mortality and disability 1 year after the procedure. Results The cohort was composed of 1,020 patients with a median age of 82 years. Depending on the scale used, the prevalence of frailty ranged from 26{\%} to 68{\%}. Frailty as measured by the EFT was the strongest predictor of death at 1 year (adjusted odds ratio [OR]: 3.72; 95{\%} confidence interval [CI]: 2.54 to 5.45) with a C-statistic improvement of 0.071 (p < 0.001) and integrated discrimination improvement of 0.067 (p < 0.001). Moreover, the EFT was the strongest predictor of worsening disability at 1 year (adjusted OR: 2.13; 95{\%} CI: 1.57 to 2.87) and death at 30 days (adjusted OR: 3.29; 95{\%} CI: 1.73 to 6.26). Conclusions Frailty is a risk factor for death and disability following TAVR and SAVR. A brief 4-item scale encompassing lower-extremity weakness, cognitive impairment, anemia, and hypoalbuminemia outperformed other frailty scales and is recommended for use in this setting. (Frailty Assessment Before Cardiac Surgery & Transcatheter Interventions; NCT01845207)",
author = "Jonathan Afilalo and Sandra Lauck and Kim, {Dae H.} and Thierry Lef{\`e}vre and Nicolo Piazza and Kevin Lachapelle and Giuseppe Martucci and Andre Lamy and Marino Labinaz and Peterson, {Mark D.} and Arora, {Rakesh C.} and Nicolas Noiseux and Andrew Rassi and Palacios, {Igor F.} and Philippe G{\'e}n{\'e}reux and Lindman, {Brian R.} and Asgar, {Anita W.} and Kim, {Caroline A.} and Amanda Trnkus and Morais, {Jos{\'e} A.} and Yves Langlois and Rudski, {Lawrence G.} and Morin, {Jean Francois} and Popma, {Jeffrey J.} and Webb, {John G.} and Perrault, {Louis P.}",
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Afilalo, J, Lauck, S, Kim, DH, Lefèvre, T, Piazza, N, Lachapelle, K, Martucci, G, Lamy, A, Labinaz, M, Peterson, MD, Arora, RC, Noiseux, N, Rassi, A, Palacios, IF, Généreux, P, Lindman, BR, Asgar, AW, Kim, CA, Trnkus, A, Morais, JA, Langlois, Y, Rudski, LG, Morin, JF, Popma, JJ, Webb, JG & Perrault, LP 2017, 'Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study', Journal of the American College of Cardiology, vol. 70, no. 6, pp. 689-700. https://doi.org/10.1016/j.jacc.2017.06.024

Frailty in Older Adults Undergoing Aortic Valve Replacement : The FRAILTY-AVR Study. / Afilalo, Jonathan; Lauck, Sandra; Kim, Dae H.; Lefèvre, Thierry; Piazza, Nicolo; Lachapelle, Kevin; Martucci, Giuseppe; Lamy, Andre; Labinaz, Marino; Peterson, Mark D.; Arora, Rakesh C.; Noiseux, Nicolas; Rassi, Andrew; Palacios, Igor F.; Généreux, Philippe; Lindman, Brian R.; Asgar, Anita W.; Kim, Caroline A.; Trnkus, Amanda; Morais, José A.; Langlois, Yves; Rudski, Lawrence G.; Morin, Jean Francois; Popma, Jeffrey J.; Webb, John G.; Perrault, Louis P.

In: Journal of the American College of Cardiology, Vol. 70, No. 6, 08.08.2017, p. 689-700.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Frailty in Older Adults Undergoing Aortic Valve Replacement

T2 - The FRAILTY-AVR Study

AU - Afilalo, Jonathan

AU - Lauck, Sandra

AU - Kim, Dae H.

AU - Lefèvre, Thierry

AU - Piazza, Nicolo

AU - Lachapelle, Kevin

AU - Martucci, Giuseppe

AU - Lamy, Andre

AU - Labinaz, Marino

AU - Peterson, Mark D.

AU - Arora, Rakesh C.

AU - Noiseux, Nicolas

AU - Rassi, Andrew

AU - Palacios, Igor F.

AU - Généreux, Philippe

AU - Lindman, Brian R.

AU - Asgar, Anita W.

AU - Kim, Caroline A.

AU - Trnkus, Amanda

AU - Morais, José A.

AU - Langlois, Yves

AU - Rudski, Lawrence G.

AU - Morin, Jean Francois

AU - Popma, Jeffrey J.

AU - Webb, John G.

AU - Perrault, Louis P.

PY - 2017/8/8

Y1 - 2017/8/8

N2 - Background Frailty is a geriatric syndrome that diminishes the potential for functional recovery after a transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its integration in clinical practice has been limited by a lack of consensus on how to measure it. Objectives This study sought to compare the incremental predictive value of 7 different frailty scales to predict poor outcomes following TAVR or SAVR. Methods A prospective cohort of older adults undergoing TAVR or SAVR was assembled at 14 centers in 3 countries from 2012 to 2016. The following frailty scales were compared: Fried, Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia, and the Essential Frailty Toolset (EFT). Outcomes of interest were all-cause mortality and disability 1 year after the procedure. Results The cohort was composed of 1,020 patients with a median age of 82 years. Depending on the scale used, the prevalence of frailty ranged from 26% to 68%. Frailty as measured by the EFT was the strongest predictor of death at 1 year (adjusted odds ratio [OR]: 3.72; 95% confidence interval [CI]: 2.54 to 5.45) with a C-statistic improvement of 0.071 (p < 0.001) and integrated discrimination improvement of 0.067 (p < 0.001). Moreover, the EFT was the strongest predictor of worsening disability at 1 year (adjusted OR: 2.13; 95% CI: 1.57 to 2.87) and death at 30 days (adjusted OR: 3.29; 95% CI: 1.73 to 6.26). Conclusions Frailty is a risk factor for death and disability following TAVR and SAVR. A brief 4-item scale encompassing lower-extremity weakness, cognitive impairment, anemia, and hypoalbuminemia outperformed other frailty scales and is recommended for use in this setting. (Frailty Assessment Before Cardiac Surgery & Transcatheter Interventions; NCT01845207)

AB - Background Frailty is a geriatric syndrome that diminishes the potential for functional recovery after a transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its integration in clinical practice has been limited by a lack of consensus on how to measure it. Objectives This study sought to compare the incremental predictive value of 7 different frailty scales to predict poor outcomes following TAVR or SAVR. Methods A prospective cohort of older adults undergoing TAVR or SAVR was assembled at 14 centers in 3 countries from 2012 to 2016. The following frailty scales were compared: Fried, Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia, and the Essential Frailty Toolset (EFT). Outcomes of interest were all-cause mortality and disability 1 year after the procedure. Results The cohort was composed of 1,020 patients with a median age of 82 years. Depending on the scale used, the prevalence of frailty ranged from 26% to 68%. Frailty as measured by the EFT was the strongest predictor of death at 1 year (adjusted odds ratio [OR]: 3.72; 95% confidence interval [CI]: 2.54 to 5.45) with a C-statistic improvement of 0.071 (p < 0.001) and integrated discrimination improvement of 0.067 (p < 0.001). Moreover, the EFT was the strongest predictor of worsening disability at 1 year (adjusted OR: 2.13; 95% CI: 1.57 to 2.87) and death at 30 days (adjusted OR: 3.29; 95% CI: 1.73 to 6.26). Conclusions Frailty is a risk factor for death and disability following TAVR and SAVR. A brief 4-item scale encompassing lower-extremity weakness, cognitive impairment, anemia, and hypoalbuminemia outperformed other frailty scales and is recommended for use in this setting. (Frailty Assessment Before Cardiac Surgery & Transcatheter Interventions; NCT01845207)

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