Prognostic value of the modified frailty index-5 for early and long-term outcomes in patients undergoing transcatheter aortic valve implantation

Q: What are the key findings of this study?

Frailty (MFI-5 ≥2) was independently associated with higher in-hospital mortality after TAVI (OR 2.38, 95% CI 1.07–5.13, p=0.025), but not with adjusted long-term mortality (HR 1.82, p=0.253).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=1260). Intervention: Frailty (5-item Modified Frailty Index [MFI-5] score ≥2) vs. Non-frail (MFI-5 score = 0). Primary outcome: In-hospital mortality (OR 2.38, 95% CI 1.07–5.13, p=0.025).

Q: What does this research mean for the field?

Frailty assessed by the 5-item Modified Frailty Index is independently associated with increased in-hospital mortality and acute kidney injury following transcatheter aortic valve implantation, but is not independently associated with long-term mortality after multivariable adjustment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Büşra Güvendi Şengör; Aykun Hakgör; Barkın Kültürsay; Mustafa Ferhat Keten; İsmail Balaban; Tuba Unkun; Cemalettin Yılmaz; Elnur Alızade; Regayi̇p Zehi̇r

doi:10.1186/s12877-026-08540-1

October 30, 2026BMC GeriatricsOpen Access

Prognostic value of the modified frailty index-5 for early and long-term outcomes in patients undergoing transcatheter aortic valve implantation

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Key result

Frailty linked to ~2.4-fold higher in-hospital mortality after TAVI, but not long-term mortality.

OR 2.38
95% CI 1.07–5.13
P=0.025
n=1,260

Why the study?

Frailty is an important determinant of outcomes in patients undergoing TAVI, prompting evaluation of the prognostic value of the 5-item Modified Frailty Index (MFI-5) for early and long-term outcomes.

Does frailty assessed by the 5-item Modified Frailty Index (MFI-5) predict early in-hospital and long-term mortality in patients undergoing transcatheter aortic valve implantation (TAVI)?

Study Design

Type

Cohort (n=1,260)

Multicenter

No

Structured PICO

Does frailty assessed by the 5-item Modified Frailty Index (MFI-5) predict early in-hospital and long-term mortality in patients undergoing transcatheter aortic valve implantation (TAVI)?

P

Population

1,260 older adults (mean age 78.7 years, 46.3% female) with severe aortic stenosis undergoing transfemoral TAVI at a single center in Turkey, followed for a median of 26 months.

E

Exposure

Frailty assessment using the 5-item Modified Frailty Index (MFI-5, derived from hypertension, diabetes mellitus, congestive heart failure, COPD, and functional dependency), categorizing patients as frail (score ≥2) or pre-frail (score = 1) prior to transfemoral TAVI.

C

Comparator

Non-frail status (MFI-5 score = 0) prior to transfemoral TAVI.

O

Outcome

In-hospital mortality and long-term all-cause mortality (occurring after hospital discharge) at a median follow-up of 26 months.hard clinical

Main Result

Odds Ratio: 2.38 (95% CI 1.07–5.13)

Absolute Event Rate: 8.8% vs 14.1%

p-value: p=0.025

In patients undergoing TAVI, frailty assessed by the MFI-5 independently predicts early vulnerability (in-hospital mortality and acute kidney injury), whereas long-term survival is driven by age, LVEF, renal function, and serum albumin rather than MFI-5 score.

Limitations

Retrospective and single-center design with potential selection bias and residual confounding
MFI-5 may not fully capture the multidimensional nature of frailty
Frailty status was only assessed at baseline without evaluating changes during follow-up
Potential confounders such as procedural strategies and operator experience were not included in multivariable models
Frailty status was only assessed at baseline and potential changes during follow-up could not be evaluated

Implication

MFI-5 frailty was associated with higher in-hospital TAVI mortality; leaves open its added value for long-term risk stratification beyond age, LVEF, and renal function.

Abstract

Frailty is an important determinant of outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and can be assessed using the 5-item Modified Frailty Index (MFI-5). This study aimed to evaluate the prognostic value of the MFI-5 for early and long-term outcomes after TAVI. In this retrospective, single-center study, 1260 patients who underwent TAVI between January 2018 and March 2025 were included. Frailty was assessed using the MFI-5 and patients were categorized as non-frail, pre-frail, or frail. The primary outcomes were in-hospital mortality and long-term mortality. Secondary outcomes included postprocedural acute kidney injury (AKI), vascular complications, and permanent pacemaker implantation. Multivariate Cox and logistic regression analyses were performed. Frail patients exhibited a higher burden of comorbidities and a more adverse outcome. Frailty was independently associated with increased in-hospital mortality and postprocedural AKI (OR 2.38, 95% CI 1.07–5.13, p = 0.025; OR 3.48, 95% CI 1.26–14.4, p = 0.038; respectively). In contrast, frailty status was not independently associated with long-term mortality after adjustment for confounders. Instead, advanced age, lower LVEF, higher creatinine levels, and lower albumin levels emerged as independent predictors of long-term mortality (HR 1.04, 95% CI 1.02–1.07, p = 0.002; HR 0.97, 95% CI 0.95–0.98, p < 0.001; HR 1.21, 95% CI 1.00-1.45, p = 0.045; HR 0.63, 95% CI 0.49–0.82, p < 0.001; respectively). Frailty was associated with increased in-hospital mortality and postprocedural AKI in patients undergoing TAVI; however, MFI-5 was not independently associated with long-term mortality after adjustment in this cohort. These findings suggest that frailty may reflect early vulnerability to procedural stress, whereas long-term outcomes appear to be more strongly associated with cardiac, renal and nutritional factors. Not applicable.

Discussion

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Cite This Study

Şengör et al. (2026) conducted a cohort in Severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=1,260). Frailty (5-item Modified Frailty Index [MFI-5] score ≥2) vs. Non-frail (MFI-5 score = 0) was evaluated on In-hospital mortality (OR 2.38, 95% CI 1.07–5.13, p=0.025). Frailty (MFI-5 ≥2) was independently associated with higher in-hospital mortality after TAVI (OR 2.38, 95% CI 1.07–5.13, p=0.025), but not with adjusted long-term mortality (HR 1.82, p=0.253).

synapsesocial.com/papers/6ae682bde432e7a5c4ef36d0 https://doi.org/10.1186/s12877-026-08540-1

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Prognostic value of the modified frailty index-5 for early and long-term outcomes in patients undergoing transcatheter aortic valve implantation

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Prognostic value of the modified frailty index-5 for early and long-term outcomes in patients undergoing transcatheter aortic valve implantation

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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