title: Frailty Status and Outcomes After Transcatheter Aortic Valve Implantation.
abstract: Frailty is a syndrome of older adults associated with increased morbidity and mortality. We aimed to assess the impact of frailty status on outcomes after transcatheter aortic valve implantation (TAVI). We reviewed all 191 patients who underwent a modified Fried frailty assessment before TAVI between February 2012 and September 2015 at a single academic medical center, and we assessed the impact of preoperative frailty status on morbidity, mortality, and health care utilization after TAVI. Frailty, pre-frailty, and nonfrailty were present in 33% (n = 64), 37% (n = 70), and 30% (n = 57) of patients, respectively. Slowness (75% vs 54%, p = 0.003) and low physical activity (55% vs 31%, p = 0.001) were more common in women than men. With increasing frailty status, the proportion of women increased (35% nonfrail, 44% pre-frail, and 66% frail, p = 0.002) and stature decreased (1.68 ± 0.11 m nonfrail, 1.66 ± 0.11 m pre-frail, 1.62 ± 0.12 m frail, p = 0.028). There was no difference in post-TAVI 30-day mortality, stroke, major vascular injury, major or life-threatening bleeding, respiratory failure, mean hospital length of stay, 30-day hospital re-admission, or overall survival between groups. The rate of discharge to a rehabilitation facility increased with increasing frailty status (14% nonfrail, 22% pre-frail, and 39% frail, p = 0.005). Frailty was independently associated with discharge to a rehabilitation facility (odds ratio 4.80, 95% confidence interval 1.66 to 13.85, p = 0.004). In conclusion, the safety of TAVI is not affected by frailty status, but patients with frailty are less likely to be discharged directly home after TAVI.
authors.affiliation: Tomsich Family, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Chetan P
authors.initials: CP
authors.lastname: Huded
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Huded
authors.affiliation: Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Friedman
authors.affiliation: Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lillian R
authors.initials: LR
authors.lastname: Benck
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Lindquist
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Holly
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ranya N
authors.initials: RN
authors.lastname: Sweis
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Ricciardi
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Davidson
authors.affiliation: Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Electronic address: jflahert@nm.org.
authors.forename: James D
authors.initials: JD
authors.lastname: Flaherty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement; D014481:United States / Q000453:epidemiology