The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: A single-center experience

Philip Green, Abigail E. Woglom, Philippe Genereux, Benoit Daneault, Jean Michel Paradis, Susan Schnell, Marian Hawkey, Mathew S. Maurer, Ajay J. Kirtane, Susheel Kodali, Jeffrey W. Moses, Martin B. Leon, Craig R. Smith, Mathew Williams

Research output: Contribution to journalArticle

252 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)974-981
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume5
Issue number9
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

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Aortic Valve Stenosis
Survival
Mortality
Thoracic Surgery
Transcatheter Aortic Valve Replacement
Hand Strength
Activities of Daily Living
Acute Kidney Injury
Serum Albumin
Blood Vessels
Heart Diseases
Length of Stay
Stroke
Confidence Intervals
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Green, Philip ; Woglom, Abigail E. ; Genereux, Philippe ; Daneault, Benoit ; Paradis, Jean Michel ; Schnell, Susan ; Hawkey, Marian ; Maurer, Mathew S. ; Kirtane, Ajay J. ; Kodali, Susheel ; Moses, Jeffrey W. ; Leon, Martin B. ; Smith, Craig R. ; Williams, Mathew. / The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis : A single-center experience. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 9. pp. 974-981.
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title = "The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: A single-center experience",
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.",
author = "Philip Green and Woglom, {Abigail E.} and Philippe Genereux and Benoit Daneault and Paradis, {Jean Michel} and Susan Schnell and Marian Hawkey and Maurer, {Mathew S.} and Kirtane, {Ajay J.} and Susheel Kodali and Moses, {Jeffrey W.} and Leon, {Martin B.} and Smith, {Craig R.} and Mathew Williams",
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Green, P, Woglom, AE, Genereux, P, Daneault, B, Paradis, JM, Schnell, S, Hawkey, M, Maurer, MS, Kirtane, AJ, Kodali, S, Moses, JW, Leon, MB, Smith, CR & 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, vol. 5, no. 9, pp. 974-981. https://doi.org/10.1016/j.jcin.2012.06.011

The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis : A single-center experience. / Green, Philip; Woglom, Abigail E.; Genereux, Philippe; Daneault, Benoit; Paradis, Jean Michel; Schnell, Susan; Hawkey, Marian; Maurer, Mathew S.; Kirtane, Ajay J.; Kodali, Susheel; Moses, Jeffrey W.; Leon, Martin B.; Smith, Craig R.; Williams, Mathew.

In: JACC: Cardiovascular Interventions, Vol. 5, No. 9, 01.09.2012, p. 974-981.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis

T2 - 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 - 2012/9/1

Y1 - 2012/9/1

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.

AB - 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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