title: The frailty syndrome and mortality among very old patients with symptomatic severe aortic stenosis under different treatments.
abstract: BACKGROUND
  The role of frailty as a prognostic factor in non-selected patients with symptomatic severe aortic stenosis (SAS) is still uncertain. This study aims to examine the association between the frailty syndrome and mortality among very old patients with symptomatic SAS, and to assess whether the association varies with the type of SAS treatment.
  
  
  RESULTS
  Prospective study of 606 patients aged ≥75years with symptomatic SAS, recruited from February 2010 to January 2015, who were followed up through June 2015. At baseline, frailty was defined as having at least three of the following five criteria: muscle weakness, slow gait speed, low physical activity, exhaustion, and unintentional weight loss. Statistical analyses were performed with multivariate Cox regression. At baseline, 49.3% patients were frail. During a mean follow-up of 98weeks, 35.3% of patients died. The hazard ratio (95% confidence interval) of mortality among frail versus non-frail patients was 1.83 (1.33-2.51). The corresponding results were 1.58 (1.09-2.28) among patients under medical treatment, 3.06 (1.25-7.50) in those with transcatheter aortic valve replacement, and 1.97 (0.83-4.67) in those with surgical aortic valve replacement, p for interaction=0.21. When the frailty criteria were considered separately, mortality was also higher among patients with slow gait speed [1.52 (1.05-2.19)] or low physical activity [1.35 (1.00-1.85)].
  
  
  CONCLUSIONS
  Frailty is associated with increased mortality among patients with symptomatic SAS, and this association does not vary with the type of SAS treatment. Future studies evaluating the benefits of different treatments in SAS patients should account for baseline frailty.
authors.affiliation: Department of Geriatric Medicine, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain; University of Lincoln and Lincoln County Hospital, Lincoln, United Kingdom. Electronic address: CRodriguezpascual@lincoln.ac.uk.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez-Pascual
authors.affiliation: Department of Cardiology, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Paredes-Galán
authors.affiliation: Department of Geriatric Medicine, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Ferrero-Martínez
authors.affiliation: Department of Interventional Cardiology, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Baz-Alonso
authors.affiliation: Department of Cardiovascular Surgery, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Darío
authors.initials: D
authors.lastname: Durán-Muñoz
authors.affiliation: Department of Cardiology, Complejo Hospitalario de Pontevedra, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: González-Babarro
authors.affiliation: Department of Cardiology, POVISA Hospital, Madrid, Spain.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Sanmartín
authors.affiliation: Department of Geriatric Medicine, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Parajes
authors.affiliation: Department of Geriatric Medicine, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Ivett
authors.initials: I
authors.lastname: Torres-Torres
authors.affiliation: Department of Cardiovascular Surgery, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Piñón-Esteban
authors.affiliation: Department of Cardiology, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Calvo-Iglesias
authors.affiliation: Department of Geriatric Medicine, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Olcoz-Chiva
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D018908:Muscle Weakness; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013223:Statistics as Topic; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000401:mortality; D000072797:Walking Speed; D015431:Weight Loss
keywords: Aortic stenosis; Frailty; Mortality; Older adults