Abstract
Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95% confidence interval (CI) 6.50–33.30) and lower serum albumin level (highest HR: 3.12; 95% CI 1.80–5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95% CI 2.71–86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55–4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty.
Highlights
The proportion of older people (>65 years) is predicted to constantly increase in Europe and reach around 30% of the total population by 2060 [1]
All studies were of observational design and most of the findings referred to short- and long-term mortality
Besides a distinct heterogeneity of frailty definitions and assessments used across the included studies, the main finding of our systematic review is that single markers of frailty are the most frequently used tools to identify frailty in older transcatheter aortic valve implantation (TAVI) patients, especially parameters of physical functionality and malnutrition
Summary
The proportion of older people (>65 years) is predicted to constantly increase in Europe and reach around 30% of the total population by 2060 [1]. These significant changes to society’s structure must be taken into account by the healthcare system. Frailty is a complex clinical condition [4], where physiological deteriorations related to the aging process are accentuated and vulnerability to stressors increases [5,6]. According to the definition of physical frailty, malnutrition, unintentional weight loss, decreased strength and endurance as well as impaired physiological functions characterize the frail population [4,7].
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