A novel Geriatric Assessment frailty score predicts two-year mortality after Transcatheter Aortic Valve implantation.

Skaar, Elisabeth; Eide, Leslie Sofia Pareja; Norekvål, Tone Merete; Ranhoff, Anette Hylen; Nordrehaug, Jan Erik; Forman, Daniel Edward; Schoenenberger, Andreas; Ove Hufthammer, Karl; Kuiper, Karel Kier-Jan; Bleie, Øyvind; Langørgen, Jørund; Haaverstad, Rune; Schaufel, Margrethe Aase (2019). A novel Geriatric Assessment frailty score predicts two-year mortality after Transcatheter Aortic Valve implantation. European heart journal. Quality of care & clinical outcomes, 5(2), pp. 153-160. Oxford University Press 10.1093/ehjqcco/qcy044

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Aims

Established surgical scores have limitations in delineating risk among candidates for transcatheter aortic valve implantation (TAVI). Assessment of frailty might help estimate themortality risk and identify patients likely to benefit from treatment. The aim of the study was to develop a frailty score to guide the decision for TAVI.

Methods and results

We conducted a prospective observational study in patients ≥ 70 yearsreferred for TAVI during 2011-2015. A Heart Team had declined the patients for open heart surgery due to high risk but accepted them for TAVI. Prior to the procedure, a geriatric assessment (GA) was performed. Based on this, an 8-element frailty score with a 0-9 (least frail-most frail) scale was developed. A total of 142 patients, 54% women, mean age 83 (SD 4) years, with severe and symptomatic aortic stenosis were assessed. All-cause two-year mortality was 11%. The novel GA frailty score predicted two-year mortality in Cox analyses, also when adjusted for age, gender and logistic EuroSCORE (HR 1.75, 95% CI: 1.28-2.42, P < 0.001). A ROC curve analysis indicated that a GA frailty score cut-off at ≥ 4 predicted two-year mortality with a specificity of 80% (95% CI: 73%-86%) and a sensitivity of 60% (95% CI: 36%-80%). The area under the curve was 0.81 (CI 0.71-0.90).

Conclusion

A novel 8-element GA frailty score identified gradations in survival in patients declined for open heart surgery. Patients with higher GA frailty scores had significantly higher two-year mortality after TAVI.

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