title: Frailty Assessed by the FORECAST Is a Valid Tool to Predict Short-Term Outcome After Transcatheter Aortic Valve Replacement.
abstract: OBJECTIVE
  The term frailty is frequently used during decision-making in transcatheter heart valve procedures. Nevertheless, frailty is still measured by eyeballing rather than by using standardized frailty assessments. In a previous study, we developed a frailty score in a cardiac surgical patient population including patients, who underwent transcatheter aortic valve replacement (TAVR). Here, we present the results from the subsequent validation study focusing on the TAVR cohort.
  
  
  METHODS
  One hundred thirty patients underwent TAVR. Frailty assessment using the FORECAST (Frailty predicts death One yeaR after Elective CArdiac Surgery Test) was performed. The European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons (STS) score were assessed as well. Follow-up included assessment of in-hospital and 30-day mortality and morbidity and quality of life using the Short Form-36 questionnaire.
  
  
  RESULTS
  Mean age was 83.3 years, and 50% were female. Logistic European System for Cardiac Operative Risk Evaluation was 14.9 ± 8.7%, and STS score was 5.1 ± 3.4%. Mean ± standard deviation FORECAST score was 4.8 ± 3.3 points of 15. In-hospital and 30-day mortality were 6.9% and 7.7%, respectively. Thirty-day Short Form-36 assessment showed a decrease in quality of life in five of ten items after the intervention. Receiver operating characteristic curves showed that the FORECAST is a valid tool to predict in-hospital mortality (area under the receiver operating characteristic curve, 0.73). By combining the FORECAST and the STS score, this effect was even higher (area under the receiver operating characteristic curve, 0.77; P = 0.021). Stratifying the patients according to the FORECAST score showed best survival in the lowest frailty group.
  
  
  CONCLUSIONS
  The FORECAST is a valid tool to assess frailty in TAVR patients. The FORECAST is easily assessable and can be included in daily clinical routine.
authors.affiliation: From the *Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany; ‡Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany; and §Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Kobe
authors.forename: Alexander
authors.initials: A
authors.lastname: Meyer
authors.forename: Hassan
authors.initials: H
authors.lastname: Elmubarak
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Jovana
authors.initials: J
authors.lastname: Pavicevic
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Simon H
authors.initials: SH
authors.lastname: Sündermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D018579:Patient Selection; D011788:Quality of Life; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*; D016896:Treatment Outcome