Prognostic impact of geriatric frailty profile after transcatheter aortic valve replacement (TAVR): a registry study of a tertiary referral hospital

Abstract

Abstract Background Assessment of frailty in patients screened for transcatheter aortic valve replacement (TAVR) can improve outcome prediction after TAVR. However, previous studies evaluating frailty indicators in this population provided heterogenic results because of the wide variety of tests and cut-off values used to assess frailty1,2. Recently, the comprehensive geriatric assessment frailty index (CGA-FI) was introduced to ensure a standardized evaluation of patient frailty3. Purpose The aim of our study was to evaluate the potential value of frailty assessment by the CGA-FI for outcome prediction in TAVR patients. The prognostic effect of the geriatric profile including nutrition, cognition, mobility and depression was also examined. Methods A total of 102 patients treated by TAVR between 2015 and 2020 were included retrospectively. Demographic, medical history, hemodynamic, geriatric, procedural, hospital stay, and 2 years follow-up data were collected. The primary study endpoint was defined as 2-year all-cause mortality. The secondary endpoint was defined as lack of dyspnea improvement at 2-year follow-up. Results Mean patient age was 84.2 ± 4.3 years and 14% of patients were classified as frail according to CGA-FI > 0.2. The 2-year mortality rate after TAVR was 29.4% and lack of dyspnea improvement during follow-up was observed in 13.7% of patients. A CGA-FI > 0.2 did not predict all-cause mortality after TAVR (hazard ratio (HR): 1.302, 95% confidence interval (CI): 0.494-3.427, p=0.593 (Figure 1)). However, patients with a geriatric depression scale ≥ 5 had higher all-cause mortality risk after TAVR than patients with a geriatric depression scale < 5 (HR: 3.047, 95% CI: 1.330-6.977, p=0.008 (Figure 1)). Similarly, malnutrition status was associated with higher all-cause mortality and shorter survival time after TAVR (HR: 2.340, 95% CI: 1.008-5.432, p=0.048 (Figure 1)). In contrast, no association of CGA-FI and geriatric profile with 2-year lack of dyspnea improvement was observed. Conclusions A CGA-FI > 0.2 was not associated with 2 years patient mortality after TAVR. However, a geriatric depression scale ≥ 5 and malnutrition may be of prognostic value by predicting all-cause mortality after TAVR.