Key result
The deficit-accumulation frailty index provided better prediction of death or poor recovery at 6 months than frailty phenotype in patients undergoing SAVR or TAVR (C-statistic 0.74 vs 0.63, p=0.01).
Why the study?
Does the deficit-accumulation frailty index improve prediction of death or poor recovery compared to frailty phenotype in patients undergoing SAVR or TAVR?
Cohort (n=228)
No
Does the deficit-accumulation frailty index improve prediction of death or poor recovery compared to frailty phenotype in patients undergoing SAVR or TAVR?
Effect estimate: C-statistic 0.74 vs 0.63
p-value: p=0.01
The deficit-accumulation frailty index provides superior prediction of death or poor recovery at 6 months compared to the frailty phenotype in older patients undergoing SAVR or TAVR.
BACKGROUND: Frailty phenotype and deficit-accumulation frailty index (FI) are widely used measures of frailty. Their performance in predicting recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) has not been compared. METHODS: Patients undergoing SAVR (n = 91) or TAVR (n = 137) at an academic medical center were prospectively assessed for frailty phenotype and FI. Outcomes were death or poor recovery, defined as a decline in ability to perform 22 daily activities and New York Heart Association class 3 or 4 at 6 months after surgery. The predictive ability of frailty phenotype versus FI and their additive value to a traditional surgical risk model were evaluated using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement. RESULTS: TAVR patients had higher prevalence of phenotypic frailty (85% vs 38%, p < .001) and greater mean FI (0.37 vs 0.24, p < .001) than SAVR patients. In the overall cohort, FI had a higher C-statistic than frailty phenotype (0.74 vs 0.63, p = .01) for predicting death or poor recovery. Adding FI to the traditional model improved prediction (NRI, 26.4%, p = .02; integrated discrimination improvement, 7.7%, p < .001), while adding phenotypic frailty did not (NRI, 4.0%, p = .70; integrated discrimination improvement, 1.6%, p = .08). The additive value of FI was evident in TAVR patients (NRI, 42.8%, p < .01) but not in SAVR patients (NRI, 25.0%, p = .29). Phenotypic frailty did not add significantly in either TAVR (NRI, 6.8%, p = .26) or SAVR patients (NRI, 25.0%, p = .29). CONCLUSIONS: Deficit-accumulation FI provides better prediction of death or poor recovery than frailty phenotype in older patients undergoing SAVR and TAVR.
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Shi et al. (2018) conducted a cohort in Aortic valve replacement (SAVR or TAVR) (n=228). Deficit-accumulation frailty index (FI) vs. Frailty phenotype was evaluated on Death or poor recovery (decline in ability to perform 22 daily activities and NYHA class 3 or 4) at 6 months (C-statistic 0.74 vs 0.63, p=0.01). The deficit-accumulation frailty index provided better prediction of death or poor recovery at 6 months than frailty phenotype in patients undergoing SAVR or TAVR (C-statistic 0.74 vs 0.63, p=0.01).
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