Impact of the clinical frailty scale on long-term outcomes after transcatheter aortic valve implantation

• Published in: The American heart journal Vol. 275; pp. 141 - 150
• Main Authors: Miyawaki, Norihisa, Ishizu, Kenichi, Shirai, Shinichi, Miyahara, Katsunori, Yamamoto, Ko, Suenaga, Tomohiro, Otani, Akira, Nakano, Kenji, Fukushima, Tadatomo, Ko, Euihong, Tsuru, Yasuo, Nakamura, Miho, Morofuji, Toru, Morinaga, Takashi, Hayashi, Masaomi, Isotani, Akihiro, Ohno, Nobuhisa, Kakumoto, Shinichi, Ando, Kenji
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2024; Elsevier Limited
• Subjects: Aorta; Aortic stenosis; Aortic valve; Body mass index; Body size; Cardiovascular diseases; Chronic fatigue syndrome; Congestive heart failure; Consortia; Frailty; Geriatrics; Heart failure; Heart valves; Hospitals; Implantation; Medical prognosis; Mortality; Patients; Prostheses; Thorax; Transplants & implants; Variables; Veins & arteries; clinical frailty scale; transcatheter aortic valve implantation; structural heart disease
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2024.05.017

The semiquantitative Clinical Frailty Scale (CFS) is reportedly a useful marker for predicting short- and mid-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of CFS in patients with severe aortic stenosis undergoing TAVI.
We prospectively assessed patients undergoing TAVI in Kokura Memorial Hospital using a 9-level CFS and enrolled 1594 patients after excluding patients with CFS 8-9. The patients were divided into the low (CFS level, 1-3; N = 842), intermediate (4; N = 469), and high (5-7; N = 283) groups according to their CFS levels.
In the low, intermediate, and high groups, 3-year all-cause mortality rates were 17.4%, 29.4%, and 41.7% (P < .001) and composite rates of cardiovascular mortality and heart failure hospitalization were 12.1%, 19.1%, and 23.9% (P < .001), respectively. Multivariable analysis showed that higher frailty was independently associated with all-cause mortality (intermediate group: adjusted hazard ratio [HR], 1.63, 95% confidence interval [CI], 1.24-2.15, P < .001; high group: adjusted HR, 2.18, 95% CI, 1.59-2.99, P < .001) and composite of cardiovascular mortality and heart failure hospitalization (intermediate group: adjusted HR, 1.47, 95% CI, 1.04-2.08, P = .030; high group: adjusted HR, 1.66, 95% CI, 1.09-2.51, P = .018) and this result was consistent, irrespective of stratification based on age, sex, body mass index, left ventricular ejection fraction, Society of Thoracic Surgeons score, and New York Heart Association functional class without significant interaction.
The simple CFS tool predicts the long-term adverse outcomes post-TAVI.