Key result
Frailty was an independent predictor of deteriorated health-related quality of life 1 year after transcatheter aortic valve implantation (OR 2.24; 95% CI 1.07-4.70; P=0.003).
Why the study?
Although TAVI improves HRQoL in most patients with severe aortic stenosis, a substantial group does not benefit, prompting investigation into the impact of frailty on 1-year HRQoL.
Does frailty predict deteriorated health-related quality of life 1 year after transcatheter aortic valve implantation in patients with severe aortic stenosis?
Observational (n=239)
No
Does frailty predict deteriorated health-related quality of life 1 year after transcatheter aortic valve implantation in patients with severe aortic stenosis?
Odds Ratio: 2.24 (95% CI 1.07–4.7)
p-value: p=0.003
Frailty is an independent predictor of deteriorated health-related quality of life 1 year after TAVI, though frail patients without peripheral artery disease or renal dysfunction may still experience improvement.
Frailty may inform post-TAVI HRQoL expectations in severe aortic stenosis; leaves open whether frailty assessment or modification should guide selection or care.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) brings symptom relief and improvement in health-related quality of life (HRQoL) in the majority of patients treated for symptomatic, severe aortic stenosis. However, there is a substantial group of patients that do not benefit from TAVI. The aim of this study is to investigate the impact of frailty on HRQoL 1 year after TAVI. METHODS: The TAVI Care & Cure Program is an ongoing, prospective, observational study including patients referred for TAVI to our institution. A comprehensive geriatric assessment was performed to evaluate existence of frailty using the Erasmus Frailty Score (EFS). HRQoL was assessed using the EQ-5D-5 L at baseline and 1 year after TAVI. RESULTS: 239 patients underwent TAVI and completed HRQoL assessment 1 year after TAVI. Seventy (29.3%) patients were classified as frail (EFS ≥ 3). In non-frail patients, the EQ-5D-5 L index did not change (0.71(± 0.22) to 0.68(± 0.33) points, P = 0.22); in frail patients, the EQ-5D-5 L index decreased from 0.55(±0.26) to 0.44 points (±0.33) (P = 0.022). Frailty was an independent predictor of deteriorated HRQoL 1 year after TAVI (OR 2.24, 95% CI 1.07-4.70, P = 0.003). In frail patients, the absence of peripheral artery disease (OR 0.17, 95% 0.05-0.50, P = 0.001) and renal dysfunction (OR 0.13, 95% CI 0.04-0.41, P = <0.001) at baseline was associated with improved HRQoL 1 year after TAVI. CONCLUSION: Frailty is associated with deterioration of HRQoL 1 year after TAVI. Notably, HRQoL did improve in frail patients with no peripheral arterial disease or renal impairment at baseline.
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Goudzwaard et al. (2020) conducted an observational in Symptomatic, severe aortic stenosis (n=239). Frailty vs. Non-frail was evaluated on Deteriorated health-related quality of life (HRQoL) 1 year after TAVI (OR 2.24, 95% CI 1.07-4.70, p=0.003). Frailty was an independent predictor of deteriorated health-related quality of life 1 year after transcatheter aortic valve implantation (OR 2.24; 95% CI 1.07-4.70; P=0.003).
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