Why the study?
While TAVI improves HrQoL in high to extreme risk patients and is now considered at intermediate risk, whether HrQoL benefits are more pronounced in frail patients and those at high to extreme versus intermediate surgical risk remained unclear.
Does TAVI improve health-related quality of life more in frail patients and patients at high to extreme versus intermediate surgical risk?
Does TAVI improve health-related quality of life more in frail patients and patients at high to extreme versus intermediate surgical risk?
TAVI provides a significantly greater improvement in health-related quality of life for patients at high to extreme surgical risk compared to those at intermediate risk, though the specific impact of frailty remains inconclusive.
TAVI yields larger KCCQ gains in high/extreme- versus intermediate-risk patients; extends risk-stratified benefit evidence while frailty effects remain inconclusive.
Symptomatic aortic stenosis and frailty reduce health-related quality of life (HrQoL). Transcatheter aortic valve implantation (TAVI) in patients at high to extreme risk has been proven to have a beneficial effect on HrQoL. Currently, TAVI is also considered in patients at intermediate risk. Our meta-analysis investigates whether benefits to HrQoL after TAVI is more pronounced in frail patients and patients at high to extreme vs. intermediate surgical risk. A systematic search of the literature was performed in November 2021 and updated in November 2023 in PUBMED, EMBASE, and the Cochrane Controlled Trials Register. Statistical analysis was performed according to the inverse variance method and the random effects model. A total of 951 studies were assessed, of which 19 studies were included. Meta-analysis showed a mean increase in the Kansas City Cardiomyopathy Questionnaire (KCCQ) score of 29.6 points (6.0, 33.1) in high to extreme risk patients versus 21.0 (20.9, 21.1) in intermediate risk patients (p < 0.00001) and 24.6 points (21.5, 27.8) in frail patients versus 26.8 (20.2, 33.4) in the general TAVI population (p = 0.55). However, qualitative analyses of non-randomized studies showed the opposite results. In conclusion, TAVI improves HrQoL more in high to extreme than intermediate risk patients. Frailty’s impact on HrQoL post-TAVI is inconclusive due to varying outcomes in RCTs vs. non-RCTs.
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Velden et al. (2024) studied this question.
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