The Impact of Frailty on Patient-Centered Outcomes Following Aortic Valve Replacement.
BACKGROUND
Frailty confers risk for surgical morbidity and mortality. Whether patient-reported measures of health, well-being, or quality of life respond differently to surgery in non-frail and frail individuals is unknown.


METHODS
Older adults with severe aortic stenosis presenting for surgery were assessed for frailty using Cardiovascular Health Study Criteria. Patient-reported measures of functional capacity (Duke Activity Status Index [DASI]), physical and mental health (Medical Outcomes Study Short Form-Physical and Mental Component Scales [SF-12 PCS and SF-12 MCS, respectively]), well-being (linear analogue self-assessment [LASA]), and quality of life (LASA) were administered before and 3 months after surgery.


RESULTS
Of 103 participants (mean age of 80.6 years), 54 were frail. Frail participants had lower baseline DASI, SF-12 PCS, SF-12 MCS, physical well-being, and quality of life scores than non-frail participants. At follow-up, frail participants showed significant improvement in physical function, with DASI and SF-12 PCS scores improving by 50% and 14%, respectively. Non-frail subjects did not significantly improve in these measures. SF-12 MCS scores also improved to a greater extent in frail compared to non-frail participants (3.6 vs < 1 point). Furthermore, the frail participants improved to a greater extent than non-frail participants in physical well-being (21.6 vs 7.1 points) and quality of life measures (25.1 vs 8.7 points).


CONCLUSIONS
Frailty is prevalent in older adults with severe aortic stenosis and is associated with poor physical and mental function, physical well-being, and quality of life. In response to surgery, frail participants exhibited greater improvement in these patient-centered outcomes than non-frail peers.
Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, Minnesota.
Brian R
BR
Kotajarvi
Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota.
Marissa J
MJ
Schafer
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Elizabeth J
EJ
Atkinson
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Megan M
MM
Traynor
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Charles J
CJ
Bruce
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Kevin L
KL
Greason
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Rakesh M
RM
Suri
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Jordan D
JD
Miller
Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota.|Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.
Nathan K
NK
LeBrasseur
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000523:psychology / Q000601:surgery; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000523:psychology; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D012720:Severity of Illness Index
Aging; Healthspan; Patient-reported outcomes; Physical function; Resilience