Frailty Predicts Geriatric and Cardiovascular Adverse Outcomes After TAVR: A 5-Year Real-World Analysis

Area of Science:

• Cardiology
• Geriatric Medicine
• Health Services Research

Background:

• Transcatheter aortic valve replacement (TAVR) is increasingly used in younger, lower-risk populations.
• Chronological age alone is insufficient for risk stratification in TAVR.
• Frailty, a marker of biological aging, offers additional prognostic value.

Purpose of the Study:

• To assess the association between frailty (using the 5-factor Modified Frailty Index, MFI-5) and long-term outcomes in TAVR patients.
• To evaluate clinical and geriatric outcomes in relation to frailty status.
• To determine if MFI-5 is a valuable tool for TAVR risk stratification.

Main Methods:

• Retrospective cohort study using the TriNetX Research Network (2015-2023).
• Patients undergoing TAVR categorized into MFI-0 (robust), MFI-2 (prefrail), and MFI-5 (frail) groups.
• Propensity score matching used to compare outcomes; primary outcome was 5-year all-cause mortality; secondary outcomes included cardiovascular events and geriatric syndromes.

Main Results:

• Frail patients (MFI-5) had significantly higher 5-year mortality (27.6% vs 8.3%) compared to robust patients (MFI-0).
• Higher rates of stroke, acute coronary syndrome, and major bleeding observed in frail TAVR patients.
• Geriatric syndromes like delirium and incontinence were more prevalent in frail individuals; MFI-5 retained prognostic value across all age groups.

Conclusions:

• The Modified Frailty Index (MFI-5) effectively predicts mortality and geriatric syndromes in TAVR patients.
• MFI-5 serves as a practical tool for risk stratification, complementing chronological age assessment.
• Frailty assessment is essential for comprehensive TAVR patient management, especially in younger cohorts.