Impact of preprocedural frailty on long-term mortality after transcatheter aortic valve replacement: a systematic review and meta-analysis

Q: What are the key findings of this study?

Preprocedural frailty was associated with an 85% increased risk of long-term all-cause mortality after transcatheter aortic valve replacement (HR 1.85).

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Severe aortic stenosis (n=429827). Intervention: Preprocedural frailty vs. Non-frail. Primary outcome: Long-term all-cause mortality (beyond 1 year) (HR 1.85, 95% CI 1.51-2.25, p=<0.001).

Q: What does this research mean for the field?

Preprocedural frailty is associated with an 85% increased risk of long-term all-cause mortality in patients undergoing transcatheter aortic valve replacement. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine the association between preprocedural frailty and long-term all-cause mortality in older adults undergoing transcatheter aortic valve replacement (TAVR).

Yang Zhan; Yue Mao; Xiaolan Tang; Rong Li; Mei Li; Daoxin Hua

doi:10.1186/s12872-026-06436-x

August 6, 2026BMC Cardiovascular DisordersOpen Access

Impact of preprocedural frailty on long-term mortality after transcatheter aortic valve replacement: a systematic review and meta-analysis

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Key result

Preprocedural frailty linked to ~85% higher long-term mortality after TAVR.

HR 1.85
95% CI 1.51-2.25
P<0.001
n=429,827

Why the study?

This study aimed to investigate the association between preprocedural frailty and long-term all-cause mortality in patients undergoing TAVR.

Does preprocedural frailty increase long-term all-cause mortality in adult patients undergoing TAVR?

Key Points

To determine the association between preprocedural frailty and long-term all-cause mortality in older adults undergoing transcatheter aortic valve replacement (TAVR).
Systematically searched PubMed, Web of Science, Embase, CINAHL, Scopus, and the Cochrane Library from inception to 15 February 2026, identifying 13 cohort studies with 429,827 patients.
Assessed study quality using the Newcastle–Ottawa Scale and conducted a random-effects meta-analysis pooling adjusted hazard ratios across 8 studies comprising 4,726 patients.
Preprocedural frailty was significantly associated with higher long-term all-cause mortality following TAVR (HR = 1.85, 95% CI 1.51–2.25; p < 0.001; I² = 39.4%).
Increased mortality risk persisted across follow-up durations of >1 to <2 years (pooled HR = 1.82, 95% CI 1.26–2.63) and ≥2 years (pooled HR = 1.89, 95% CI 1.44–2.47).
Risk was consistent across assessment types, including single-domain tools (pooled HR = 1.78, 95% CI 1.42–2.25) and multidimensional instruments (pooled HR = 2.14, 95% CI 1.31–3.50).

Study Design

Type

Meta-Analysis (n=429,827)

Structured PICO

Does preprocedural frailty increase long-term all-cause mortality in adult patients undergoing TAVR?

P

Population

429,827 older adults undergoing transcatheter aortic valve replacement across 13 cohort studies, evaluated for preprocedural frailty and followed for 1.3 to 5.0 years.

E

Exposure

Preprocedural frailty or frailty-related vulnerability assessed before the index TAVR procedure using validated clinical, multidimensional, functional, nutritional, or claims-based instruments.

C

Comparator

Non-frail patients or patients with lower frailty burden.

O

Outcome

Long-term all-cause mortality (assessed beyond 1 year after the index TAVR procedure).hard clinical

Main Result

Hazard Ratio: 1.85 (95% CI 1.51–2.25)

p-value: p=<0.001

Preprocedural frailty is significantly associated with an 85% relative increase in long-term all-cause mortality risk after TAVR, supporting the incorporation of frailty assessment into routine preprocedural geriatric risk stratification.

Limitations

All included studies were observational, meaning residual confounding cannot be completely excluded.
Frailty was assessed using heterogeneous instruments and thresholds, limiting direct comparisons.
The analysis focused on all-cause mortality, so cause-specific outcomes could not be evaluated.
The review was restricted to English-language published articles, potentially introducing language and publication bias.
All included studies were observational and residual confounding could not be excluded
Limited number of included studies for subgroup analyses
Heterogeneous frailty assessment tools used across studies

Implication

Supports frailty screening in TAVR risk assessment; leaves open whether frailty modification alters mortality.

Abstract

This study aimed to investigate the association between preprocedural frailty and long-term all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR). A systematic search of PubMed, Web of Science, Embase, CINAHL, Scopus, and the Cochrane Library was conducted from database inception to 15 February 2026. The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS). A random-effects meta-analysis was performed to pool adjusted hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs). Thirteen cohort studies involving 429,827 patients were included in the systematic review. Of these, 8 studies (4,726 patients) reporting comparable adjusted effect estimates were included in the quantitative meta-analysis. Preprocedural frailty was associated with a higher risk of long-term all-cause mortality after TAVR (HR = 1.85, 95% CI 1.51–2.25; I² = 39.4%). The association was generally consistent across subgroup analyses stratified by follow-up duration and frailty assessment methodology. Five studies that were not amenable to quantitative pooling because of non-comparable effect formats or data structures showed a concordant direction of effect, with some studies demonstrating a graded relationship between increasing frailty burden and mortality risk. Preprocedural frailty is significantly associated with increased long-term all-cause mortality in older adults undergoing TAVR. These findings support the incorporation of frailty assessment into routine preprocedural geriatric risk stratification and multidisciplinary decision-making.

Discussion

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Cite This Study

Zhan et al. (2026) conducted a meta-analysis in Severe aortic stenosis (n=429,827). Preprocedural frailty vs. Non-frail was evaluated on Long-term all-cause mortality (beyond 1 year) (HR 1.85, 95% CI 1.51-2.25, p=<0.001). Preprocedural frailty was associated with an 85% increased risk of long-term all-cause mortality after transcatheter aortic valve replacement (HR 1.85).

synapsesocial.com/papers/6a76db2df12abadc79816348 https://doi.org/10.1186/s12872-026-06436-x

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Impact of preprocedural frailty on long-term mortality after transcatheter aortic valve replacement: a systematic review and meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Impact of preprocedural frailty on long-term mortality after transcatheter aortic valve replacement: a systematic review and meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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