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

As transcatheter aortic valve replacement (TAVR) expands to include younger and lower-risk patients, traditional risk stratification based on chronological age may be insufficient. Frailty, a marker of biological aging, offers additional prognostic insight.

The purpose of this study was to evaluate the association between frailty, as measured by the 5-factor Modified Frailty Index (MFI-5), and long-term clinical and geriatric outcomes in patients undergoing TAVR.

Using the TriNetX Research Network, we identified patients ≥18 years who underwent TAVR from 2015 to 2023. Patients were categorized into MFI-0 (robust), MFI-2 (prefrail), and MFI-5 (frail) groups. Propensity score matching was applied for baseline characteristics. Matched cohort sizes were as follows: MFI-0 vs MFI-2 (N = 1,592 each), MFI-0 vs MFI-5 (N = 836 each), and MFI-2 vs MFI-5 (N = 1,233 each). The primary outcome was 5-year all-cause mortality. Secondary outcomes included cardiovascular events, procedural complications, and geriatric syndromes. Analyses were stratified by age groups: <65, 65 to 75, and >75 years.

Compared to the robust cohort, frail patients had significantly higher 5-year mortality (27.6% vs 8.3%; HR: 1.41; 95% CI: 1.14-1.74), stroke (21.2% vs 1.2%; HR: 18.52; 95% CI: 8.13-42.19), acute coronary syndrome (20.1% vs 1.3%; HR: 8.77; 95% CI: 4.74-16.23), and major bleeding (23.2% vs 1.2%; HR: 19.23; 95% CI: 8.47-43.48). Geriatric syndromes including delirium, incontinence, depression, and malnutrition were also more prevalent in frail patients. MFI retained prognostic value across all age strata, including patients under 65 years.

The MFI-5 is a useful tool for predicting mortality and geriatric syndromes in TAVR patients. It offers a practical approach to risk stratification, complementing chronological age.