Abstract
Guidelines suggest using frailty characteristics in the work-up for a transcatheter aortic valve implantation (TAVI). There are many frailty-screening tools with different components. The prognostic value of the individual parameters in frailty is as yet unclear. The objective of this systematic review and meta-analysis was to find and pool predictors for 1‑year mortality after TAVI. We followed a two-step approach. First, we searched for randomised controlled trials on TAVI to identify frailty parameters used in these studies. Second, we searched for publications on these frailty parameters. Articles were included for pooled analysis if the studied frailty parameters were dichotomised with clear cut-off values based on common standards or clinical practice and reported adjusted hazard ratios (HR) of 1‑year mortality after TAVI. We calculated pooled effect estimates of 49 studies based on dichotomised frailty scores (HR: 2.16, 95% CI: 1.57–3.00), chronic lung disease (HR: 1.57, 95% CI: 1.45–1.70), estimated glomerular filtration rate <30 ml/min (HR: 1.95, 95% CI: 1.68–2.29), body mass index <20 kg/m2 (HR: 1.49, 95% CI: 1.09–2.03), hypoalbuminaemia (HR: 1.77, 95% CI: 1.38–2.25), anaemia (HR: 2.08, 95% CI: 0.93–4.66), low gait speed (HR: 13.33, 95% CI: 1.75–101.49) and Katz activities of daily living (ADL) score of 1 or more deficits (HR: 5.16, 95% CI: 0.77–34.47). Chronic lung disease, chronic kidney disease, underweight, hypoalbuminaemia, a low frailty score, anaemia, low gait speed and an ADL deficiency were associated with worse 1‑year outcomes after TAVI.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01379-0) contains supplementary material, which is available to authorized users.
Highlights
Aortic valve stenosis is the most prevalent valvular heart disease in the Western population and is associated with ageing
Some studies reported both on univariate and multivariate results of hazard ratios (HRs) of the frailty characteristic for 1-year mortality
An overview and comparison of univariate and multivariate HR per variable can be found in the Electronic Supplementary Material
Summary
Aortic valve stenosis is the most prevalent valvular heart disease in the Western population and is associated with ageing. Transcatheter aortic valve implantation (TAVI) has evolved as a routine treatment for patients with severe aortic valve stenosis at high or prohibitive risk for surgical aortic valve replacement [1, 2]. TAVI-specific risk stratification models are currently lacking as surgical risk models poorly predict TAVI outcomes [3, 4]. Guidelines suggest using frailty characteristics in the selection of patients for TAVI [1, 2]. Frailty is associated with diminished outcomes and increased risk of mortality and morbidity after surgical procedures. There are numerous methods to assess frailty, a standard and objective measurement method is lacking [6], and most consist of the quantification or dichotomisation of comorbidities. According to the Fried criteria, a patient is frail if three of the following criteria are met: a decline in lean body mass, strength, endurance, balance, walking performance and low physical activity
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