title: Poor mobility predicts adverse outcome better than other frailty indices in patients undergoing transcatheter aortic valve implantation.
abstract: BACKGROUND
  Surgical risk scoring systems are poor at predicting outcome in patients undergoing transcatheter aortic valve implantation (TAVI). Frailty indices might more accurately predict outcome.
  
  
  OBJECTIVE
  To examine multiple frailty indices as markers of performance to see whether they predict outcomes both in the shorter (30 days) and longer terms (5 years) in patients who have undergone TAVI.
  
  
  METHODS
  Frailty indices (Mobility; Brighton Mobility Index, New York Heart Association (NYHA), Karnofsky Performance Index, Canadian Study Health Association (CSHA) clinical frailty scale, and Katz Index of Dependence) were assessed in 312 consecutive TAVI patients. Mortality tracking was obtained from the Office of National Statistics as of May 2014.
  
  
  RESULTS
  Mean age was 81.2 ± 7.0 years; 53.2% were male. Mean Logistic EuroSCORE and STS were 17.4 ± 9.4 and 4.6 ± 2.8, respectively. Mean peak aortic valve gradient and aortic valve area were 79.1 ± 28.0 mm Hg and 0.72 ± 0.25 cm(2) , respectively. 30-day mortality was 4.8%; long-term mortality (maximum 5.8 years, mean 2.2 ± 1.5 years) was 25.3%. Both univariate and multivariate analyses confirmed poor mobility (defined as severe impairment of mobility secondary to musculoskeletal or neurological dysfunction (Euroscore II risk)), as the best predictor of adverse outcome over both the short-term (OR 4.03, 95% CI (1.36-11.96), P = 0.012 (30 days)) and longer term (OR 2.15, 95% CI (1.33-3.48), P = 0.002, (2.2 ± 1.5 years.)).
  
  
  CONCLUSIONS
  Poor mobility predicts worse survival among patients undergoing TAVI, both in the shorter and longer terms. Our data suggest that mobility impairment, of either neurological or musculoskeletal etiology, is an appropriate screening measure when considering patients for TAVI.
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Cockburn
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Meera Sundar
authors.initials: MS
authors.lastname: Singh
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Nur Hanis Mohammed
authors.initials: NH
authors.lastname: Rafi
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Maureen
authors.initials: M
authors.lastname: Dooley
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Nevil
authors.initials: N
authors.lastname: Hutchinson
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Uday
authors.initials: U
authors.lastname: Trivedi
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D016208:Databases, Factual; D004739:England; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D016017:Odds Ratio; D016016:Proportional Hazards Models; D020379:Risk Adjustment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: TAVI; aortic disease; aortic valve disease; outcome predictors