Pre-operative frailty and changes in health-related quality of life after transcatheter aortic valve implantation

Introduction It is unclear if preoperative frailty status influences health-related quality of life (HRQoL) and patients’ self-rated health after transcatheter aortic valve implantation (TAVI). Therefore, we compared changes in HRQoL and self-rated health from before to 1-year after TAVI in relation to preoperative frailty level. Methods Patients >65 years accepted for TAVI at a Swedish University Hospital, were eligible for inclusion. Twelve patients (4.8%) died before the 1-year follow-up. To estimate preoperative frailty, we used Clinical Frailty Scale (CFS), divided in three frailty groups. Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EQ-VAS in EQ5D (scale 1–100) were used to evaluate patients’ HRQoL and self-rated health, pre-and postoperatively. Paired T-tests were used to compare KCCQ and EQ-VAS within frailty groups. One-way ANOVA-test was used to compare changes between groups. Results In total, 209 TAVI patients (mean age 81.7 years, (SD 4.8), 44.5% women) with measurements both before and 1-year after TAVI were included in a prospective observational study. Preoperatively, 49/209 (23%) of the patients were assessed as not frail (CFS 2-3), 123/209 (59%) as very mild frail (CFS 4) and 37/209 (18%) as mild frail (CFS 5). One year after TAVI, HRQoL improved significant in all three frailty groups. The mean differences in KCCQ in CFS 2-3 group were 11.5 (95% confidence interval (CI): 7.1–15.9), CFS 4: 17.9 (95% CI: 14.3–21.5), CFS 5; 19.3 (95% CI: 10.8–27.8). The changes did not differ significantly between the groups (p=0.12). The mean differences in EQ-VAS in CFS 2-3 were 11.2 (95% CI: 6.5–16.0); CFS 4: 12.0 (95% CI: 8.4–15.6); CFS 5: 13.9 (95 % CI: 6.1–21.8), without significant intergroup differences (p=0.82). Conclusions TAVI improved patients’ HRQoL and self-rated health. The magnitude of improvement was independent of preoperative frailty level.