Frailty Status and Outcomes After Transcatheter Aortic Valve Implantation

Area of Science:

• Gerontology
• Cardiology
• Health Services Research

Background:

• Frailty is a significant geriatric syndrome linked to adverse health outcomes, including increased morbidity and mortality.
• Transcatheter aortic valve implantation (TAVI) is a crucial intervention for older adults with aortic stenosis.
• Understanding frailty's impact on TAVI outcomes is essential for optimizing patient care and resource allocation.

Purpose of the Study:

• To evaluate the association between preoperative frailty status and outcomes following TAVI.
• To assess the influence of frailty on morbidity, mortality, and healthcare utilization after TAVI.

Main Methods:

• A retrospective review of 191 patients who underwent TAVI and a modified Fried frailty assessment.
• Categorization of patients into frail, pre-frail, and non-frail groups based on assessment.
• Analysis of postoperative outcomes including mortality, stroke, bleeding, hospital length of stay, readmission, and discharge destination.

Main Results:

• Frailty, pre-frailty, and non-frailty were identified in 33%, 37%, and 30% of patients, respectively.
• No significant differences were observed in 30-day mortality, stroke, vascular injury, bleeding, respiratory failure, hospital stay, readmission, or overall survival based on frailty status.
• The rate of discharge to a rehabilitation facility significantly increased with higher frailty status (14% non-frail, 22% pre-frail, 39% frail; p=0.005).
• Frailty was independently associated with discharge to a rehabilitation facility (OR 4.80).

Conclusions:

• Preoperative frailty status does not compromise the immediate safety of TAVI.
• Frailty is a significant predictor of post-TAVI discharge disposition, with frail patients being less likely to be discharged directly home.
• These findings highlight the importance of considering frailty in discharge planning and post-acute care strategies for TAVI patients.