title: Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI.
  
  
  RESULTS
  Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3%, p=0.04 for immediate procedural mortality; 17% vs. 5.8%, p=0.002 for 30-day mortality; and 23% vs. 6.4%, p<0.0001 for procedural mortality). The risk-score-based 30-day mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) reflected neither the observed 30-day mortality in both groups nor the threefold risk elevation in frail patients. In contrast, the Katz Index <6 was identified as a significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67 [95% CI: 1.7-4.3], p<0.0001). During follow-up (median observation period 537 days) 56% of frail vs. 24% of non-frail patients died.
  
  
  CONCLUSIONS
  Frailty status measured by the Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVI-specific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.
authors.affiliation: Department of Cardiology, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Puls
authors.forename: Bettina
authors.initials: B
authors.lastname: Sobisiak
authors.forename: Annalen
authors.initials: A
authors.lastname: Bleckmann
authors.forename: Claudius
authors.initials: C
authors.lastname: Jacobshagen
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Danner
authors.forename: Mark
authors.initials: M
authors.lastname: Hünlich
authors.forename: Tim
authors.initials: T
authors.lastname: Beißbarth
authors.forename: Friedrich
authors.initials: F
authors.lastname: Schöndube
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.forename: Ralf
authors.initials: R
authors.lastname: Seipelt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D018570:Risk Assessment; D016019:Survival Analysis