Frailty markers like slower gait speed (HR 1.98), weakness (HR 1.61), low albumin (HR 1.39), and Katz ADL impairments (HR 2.37) independently predict higher 1-year death or heart failure in elderly se
Do frailty indices predict the composite of all-cause death and heart failure admission in elderly patients with severe valvular heart disease?
Simple frailty markers including albumin, grip strength, walk speed, and ADLs independently predict 1-year mortality and heart failure admission in elderly patients with severe valvular heart disease.
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Abstract Background Frailty assessment could predict short- and long-term outcomes in patients undergoing mitral and aortic valve interventions. However, the lack of a standardized tool and the complexity of existing scales limit routine use, with most studies focusing on intervention recipients. Objectives This study examines the association between frailty indices and prognosis in elderly patients with severe valvular heart disease (VHD) using a large, nationwide prospective cohort from China. Methods A total of 2098 patients (age ≥ 65 years) with severe VHD who underwent frailty assessment were included. VHD examined included aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid regurgitation, and multivalvular heart disease. Frailty indices included albumin level, grip strength, 5-m walk speed, and Katz Activities of Daily Living (ADLs). The primary outcome is a composite of all-cause death and admission for heart failure within one year. Cox proportional hazard models are used to investigate the association of frailty indices with the primary outcome. Results At 1-year follow-up, 121 deaths (5.8%) and 67(3.2%) admissions for heart failure had occurred. Each frailty marker was stratified according to the previous validated cutoffs. Patients with any positive marker of frailty demonstrated poorer prognosis compared to those without frailty markers (slower gait speed, adjusted hazard ratio 1.98, 95% CI: 1.40 to 2.80, P 0.001; weakness, adjusted HR 1.61, 95% CI: 1.08 to 2.39, P = 0.02; low albumin, adjusted HR 1.39, 95% CI: 1.00 to 1.93, P = 0.046; ≥2 Katz ADLs impairments, adjusted HR 2.37, 95% CI: 1.67 to 3.38, P 0.001). These associations remain persistent in most types of VHDs. A frailty score, incorporating all four frailty markers, was analyzed as a continuous variable (range: 0–4). The frailty score emerged as an independent predictor of adverse outcomes (adjusted HR 1.50, 95% CI: 1.29–1.75). These findings remained robust in subgroups of patients receiving medical therapy, those with preserved left ventricular ejection fraction, and those undergoing aortic valve replacement. Conclusions The study demonstrated frailty markers of albumin level, grip strength, 5-m walk speed, and Katz ADLs are significant independent predictors of the prognosis in patients with VHDs. These markers provide a simple yet powerful risk-stratification tool, utilizing factors that are already routinely assessed in clinical practice to guide treatment decisions and optimize management for elderly patients with VHD.Adjusted Survival Curves for Each Marker
Jiang et al. (Sat,) reported a other. Frailty markers like slower gait speed (HR 1.98), weakness (HR 1.61), low albumin (HR 1.39), and Katz ADL impairments (HR 2.37) independently predict higher 1-year death or heart failure in elderly se.