Association between frailty and long-term outcomes in patients undergoing TAVI admitted to private intensive care units in Australia

Frailty is common in patients undergoing transcatheter aortic valve implantation (TAVI) and may influence post-procedural outcomes. We examined the association between frailty and long-term outcomes among patients admitted to intensive care units (ICUs) following TAVI. Retrospective multicentre registry-based cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database. Adult patients (≥16 years) admitted to private ICUs in Australia following TAVI between 1 January 2018 and 30 June 2024 were included. Frailty was assessed using the clinical frailty scale (CFS) and categorised as nonfrail (CFS 1–3), mildly frail (CFS 4–5), or moderately-to-severely frail (CFS 6–8). The primary outcome was survival up to 4 years. Secondary outcomes included in-hospital mortality, hospital length of stay, and discharge destination. Associations between frailty and survival were evaluated using Cox proportional hazards models with robust sandwich estimators. Among 3917 patients, 1598 (40.8%) were nonfrail, 1920 (49.0%) were mildly frail, and 399 (10.3%) were moderately-to-severely frail. Four-year survival was highest among nonfrail patients (73.4%; 95% confidence interval [CI], 70.1–76.8), followed by mildly frail (62.7%; 95% CI, 59.3–66.4; adjusted hazard ratio [aHR], 1.52; 95% CI, 1.33–1.73) and moderately-to-severely frail patients (44.2%; 95% CI, 37.9–51.6; aHR, 2.23; 95% CI, 1.99–2.49). Patients with moderate-to-severe frailty had higher in-hospital mortality, longer hospital stays, and less frequently discharged home. Frailty was common among patients admitted to ICU following TAVI and was independently associated with reduced long-term survival and adverse hospital outcomes. Routine frailty assessment may help inform peri-procedural risk stratification and clinical decision-making in patients undergoing TAVI.