Key result
High frailty risk linked to ~3.2-fold higher odds of prolonged hospitalization or 1-year death.
Why the study?
For frail patients with limited life expectancy, time in hospital following TAVR is an important measure of quality of life, but data remain scarce.
Does higher frailty, assessed by the Hospital Frailty Risk Score, increase the risk of prolonged hospitalization and mortality in patients post-TAVR?
Cohort (n=5,971)
Yes
Does higher frailty, assessed by the Hospital Frailty Risk Score, increase the risk of prolonged hospitalization and mortality in patients post-TAVR?
Odds Ratio: 3.17 (95% CI 2.41–4.17)
Absolute Event Rate: 42% vs 16.6%
Leveraging administrative data to compute the Hospital Frailty Risk Score can effectively identify frail patients at a substantially higher risk for prolonged hospital readmissions and 1-year mortality post-TAVR.
High frailty identifies TAVR patients at elevated risk of prolonged hospitalization or death; supports risk stratification but leaves open whether interventions improve outcomes.
Background For frail patients with limited life expectancy, time in hospital following transcatheter aortic valve replacement is an important measure of quality of life; however, data remain scarce. Thus, we aimed to investigate frailty and its relation to time in hospital during the first year after transcatheter aortic valve replacement. Methods and Results From 2008 to 2020, all Danish patients who underwent transcatheter aortic valve replacement and were alive at discharge were included. Using the validated Hospital Frailty Risk Score, patients were categorized in the low, intermediate, and high frailty groups. Time in hospital and mortality up to 1 year are reported according to frailty groups. In total, 3437 (57.6%), 2277 (38.1%), and 257 (4.3%) were categorized in the low, intermediate, and high frailty groups, respectively. Median age was ≈81 years. Female sex and comorbidity burden were incrementally higher across frailty groups (low frailty: heart failure, 24.1%; stroke, 7.2%; and chronic kidney disease, 4.5%; versus high frailty: heart failure, 42.8%; stroke, 34.2%; and chronic kidney disease, 29.2%). In the low frailty group, 50.5% survived 1 year without a hospital admission, 10.8% were hospitalized >15 days, and 5.8% of patients died. By contrast, 26.1% of patients in the high frailty group survived 1 year without a hospital admission, 26.4% were hospitalized >15 days, and 15.6% died within 1 year. Differences persisted in models adjusted for sex, age, frailty, and comorbidity burden (excluding overlapping comorbidities). Conclusions Among patients undergoing transcatheter aortic valve replacement, frailty is strongly associated with time in hospital and mortality. Prevention strategies for frail patients to reduce hospitalization burden could be beneficial.
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Strange et al. (2023) conducted a cohort in Severe aortic stenosis post-transcatheter aortic valve replacement (n=5,971). High frailty risk vs. Low frailty risk was evaluated on Composite of death or >14 days of hospitalization in the first year (OR 3.17, 95% CI 2.41-4.17). High frailty risk was strongly associated with an increased risk of spending >14 days hospitalized or dying within 1 year compared to low frailty risk (OR 3.17).
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