title: Quantitative increase in frailty is associated with diminished survival after transcatheter aortic valve replacement.
abstract: BACKGROUND
  The purpose of this study is to assess the impact of frailty index comprised of commonly used frailty metrics on outcomes following transcatheter aortic valve replacement (TAVR) outcomes, including mortality, length of stay, and discharge destination.
  
  
  RESULTS
  Retrospective data collection was performed for 342 consecutive patients who underwent TAVR at a single center from May 15, 2012, to September 17, 2015. Frailty index score was calculated using 15-ft walk test, Katz activities of daily living, preoperative serum albumin, and dominant handgrip strength. Patients were given a frailty score from 0/4 to 4/4, with higher scores indicating greater levels of frailty. There were 27 patients (8%) in 0/4, 82 patients (24%) in 1/4, 129 patients (38%) in 2/4, 73 patients (21%) in 3/4, and 31 patients (9%) in 4/4 frailty group. Multivariate cox, logistic, and linear regression analyses showed that patients with frailty score of 3/4 or 4/4 had increased all-cause mortality (P = .015 and P < .001) and were more likely to be discharged to an acute care facility (P = .083 and P = .001). 4/4 frail patients had increased post-operative length of stay (P = .014) when compared to less frail patients. Individual components of the frailty score were also independent predictors of all-cause mortality. Median survival in 4/4 frail patients was 7 months.
  
  
  CONCLUSIONS
  Frailty index comprised of commonly used frailty metrics and its components are independent predictors of poor post-TAVR outcomes. There is a stepwise increase in mortality and post-TAVR length of stay with increasing frailty with dismal prognosis in extremely frail patients.
authors.affiliation: Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ; Cardiovascular Clinical Research Unit, Barnabas Heart Hospitals, NJ. Electronic address: dhavalchauhan86@gmail.com.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Chauhan
authors.affiliation: Cardiovascular Clinical Research Unit, Barnabas Heart Hospitals, NJ.
authors.forename: Nicky
authors.initials: N
authors.lastname: Haik
authors.affiliation: Cardiovascular Clinical Research Unit, Barnabas Heart Hospitals, NJ; Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Merlo
authors.affiliation: Cardiovascular Clinical Research Unit, Barnabas Heart Hospitals, NJ; Department of Cardiology, Newark Beth Israel Medical Center, Newark, NJ.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Haik
authors.affiliation: Department of Cardiology, Newark Beth Israel Medical Center, Newark, NJ.
authors.forename: Chunguang
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Newark Beth Israel Medical Center, Newark, NJ.
authors.forename: Marc
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ.
authors.forename: Anne
authors.initials: A
authors.lastname: Mosenthal
authors.affiliation: Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ; Cardiovascular Clinical Research Unit, Barnabas Heart Hospitals, NJ.
authors.forename: Mark
authors.initials: M
authors.lastname: Russo
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013223:Statistics as Topic; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D014481:United States / Q000453:epidemiology