Key result
Preoperative frailty, assessed by dichotomised frailty scores, was associated with a significantly increased risk of 1-year mortality (HR 2.16) after transcatheter aortic valve implantation.
Why the study?
Guidelines suggest using frailty characteristics in the work-up for TAVI, but the prognostic value of individual frailty parameters was unclear.
Do preoperative frailty parameters predict 1-year mortality in patients undergoing TAVI?
Meta-Analysis
Do preoperative frailty parameters predict 1-year mortality in patients undergoing TAVI?
Hazard Ratio: 2.16 (95% CI 1.57–3)
Preoperative frailty parameters, including chronic lung disease, severe CKD, underweight, hypoalbuminaemia, and low gait speed, are significant predictors of 1-year mortality after TAVI.
Specific frailty parameters identify higher 1-year mortality risk after TAVI; leaves open need for prospective validation before routine integration.
Guidelines suggest using frailty characteristics in the work-up for a transcatheter aortic valve implantation (TAVI). There are many frailty-screening tools with different components. The prognostic value of the individual parameters in frailty is as yet unclear. The objective of this systematic review and meta-analysis was to find and pool predictors for 1‑year mortality after TAVI. We followed a two-step approach. First, we searched for randomised controlled trials on TAVI to identify frailty parameters used in these studies. Second, we searched for publications on these frailty parameters. Articles were included for pooled analysis if the studied frailty parameters were dichotomised with clear cut-off values based on common standards or clinical practice and reported adjusted hazard ratios (HR) of 1‑year mortality after TAVI. We calculated pooled effect estimates of 49 studies based on dichotomised frailty scores (HR: 2.16, 95% CI: 1.57–3.00), chronic lung disease (HR: 1.57, 95% CI: 1.45–1.70), estimated glomerular filtration rate <30 ml/min (HR: 1.95, 95% CI: 1.68–2.29), body mass index <20 kg/m2 (HR: 1.49, 95% CI: 1.09–2.03), hypoalbuminaemia (HR: 1.77, 95% CI: 1.38–2.25), anaemia (HR: 2.08, 95% CI: 0.93–4.66), low gait speed (HR: 13.33, 95% CI: 1.75–101.49) and Katz activities of daily living (ADL) score of 1 or more deficits (HR: 5.16, 95% CI: 0.77–34.47). Chronic lung disease, chronic kidney disease, underweight, hypoalbuminaemia, a low frailty score, anaemia, low gait speed and an ADL deficiency were associated with worse 1‑year outcomes after TAVI.
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Mourik et al. (2020) conducted a meta-analysis in Severe aortic valve stenosis. Dichotomised frailty scores vs. Non-frail was evaluated on 1-year all-cause mortality (HR 2.16, 95% CI 1.57-3.00). Preoperative frailty, assessed by dichotomised frailty scores, was associated with a significantly increased risk of 1-year mortality (HR 2.16) after transcatheter aortic valve implantation.
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