title: Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement.
abstract: BACKGROUND
  The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients' frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.
  
  
  METHODS
  We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.
  
  
  RESULTS
  Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman's ρ=-0.077,P=0.007), albumin (ρ=-0.22,P<0.001), gait speed (ρ=-0.28,P<0.001), and grip strength (ρ=-0.26,P<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%,P<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10-1.49;P<0.001).
  
  
  CONCLUSIONS
  In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Shimura
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. masa-nori@nms.ac.jp yamamoto@heart-center.or.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kano
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Kagase
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kodama
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Koyama
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Otsuka
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Tada
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Yamanaka
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015588:Observer Variation; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: OCEAN; clinical frailty scale; frailty; transcatheter aortic valve replacement