title: Impact of frailty on mortality after transcatheter aortic valve implantation.
abstract: BACKGROUND
  We sought to investigate the relation between frailty indices and 12-month mortality after transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  We included 101 consecutive patients with severe aortic stenosis who have undergone TAVI. Frailty indices according to Valve Academic Research Consortium-2 recommendations (5-m walk test [5MWT] and hand grip strength) as well as other available scales of frailty (Katz index, Elderly Mobility Scale [EMS], Canadian Study of Health and Aging [CSHA] scale, Identification of Seniors at Risk [ISAR] scale) were assessed at baseline. The primary endpoint was 12-month all-cause mortality.
  
  
  RESULTS
  Twelve-month all-cause mortality was 17.8%. According to 5MWT, 17.8% were frail; hand grip test: 6.9%; Katz index: 17.8%; EMS: 7.9%; CSHA scale: 16.9%; and ISAR scale: 52.5%. Associations between frailty indices and 12-month all-cause mortality after TAVI were significant in Cox regression analysis (frail vs not frail, presented as hazard ratio[95%CI] adjusted for logistic EuroSCORE): for 5MWT, 72.38 (15.95-328.44); for EMS, 23.39 (6.89-79.34); for CSHA scale, 53.97 (14.67-198.53); for Katz index, 21.69 (6.89-68.25); for hand grip strength, 51.54 (12.98-204.74); and for ISAR scale, 15.94 (2.10-120.74). Similarly, such relationship was confirmed when 5MWT, EMS, and CSHA were used as continuous variables (hazard ratio [95%CI] adjusted for logistic EuroSCORE: for 5MWT per 1-second increase, 2.55 [1.94-3.37]; for EMS per 1-point decrease, 2.90 (1.99-4.21); and for CSHA per 1-point increase, 3.13 [2.17-4.53]).
  
  
  CONCLUSIONS
  Our study confirmed a strong predictive ability of most of the proposed frailty indices for 12-month mortality after TAVI. For patients scheduled for TAVI, the use of frailty indices, which are easy and quick to assess on clinical basis but with strong performance, for example, 5MWT, EMS, or hand grip test, may be advocated.
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland. Electronic address: kleczu@interia.pl.
authors.forename: Pawel
authors.initials: P
authors.lastname: Kleczynski
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Bagienski
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Rzeszutko
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Sorysz
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Trebacz
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Sobczynski
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Tomala
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Stapor
authors.affiliation: Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D016330:Frail Elderly; D018737:Hand Strength; D006801:Humans; D008297:Male; D009026:Mortality; D016016:Proportional Hazards Models; D018570:Risk Assessment; D065467:Transcatheter Aortic Valve Replacement; D000070857:Walk Test