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PREOPERATIVE FRAILTY AS A PREDICTOR OF OUTCOMES FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS
183 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology PREOPERATIVE FRAILTY AS A PREDICTOR OF OUTCOMES FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Abstract Category: 5. ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Presentation Number: 1144-180 Authors: Atul Anand, Catherine Harley, Akila Visvanathan, Anoop Shah, Joanna Cowell, Alasdair MacLullich, Susan Shenkin, Nicholas Mills, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom Background: Current surgical prognostic calculators do not capture the risk for older patients undergoing transcatheter aortic valve implantation (TAVI). We assessed whether frailty, a reflection of physiological reserve, may be a better determinant in this population.
Methods: We conducted a systematic review of evidence published between 1st January 2000 and 30th May 2015 using the key search terms of frailty (and synonyms) and TAVI (and synonyms). Studies met the inclusion criteria by reporting: 1) any operationalised measure of frailty, and 2) post-TAVI early (≤30 days) or late (>30 days) mortality and procedural complications as defined by the Vascular Academic Research Consortium (VARC).
Results: Ten observational cohort studies (n=4,592) met the inclusion criteria. Frailty was associated with higher early mortality in four studies (n=1,900, HR 2.35, 95% CI 1.78-3.09, p<0.001), and increased late mortality in seven studies (n=3,159, HR 1.72, 95% CI 1.402.12, p<0.001)(see Figure). Use of objective tools to determine frailty identified those at even higher risk of late mortality (HR 2.63, 95% CI 1.87-3.70, p<0.001). Limited reporting of VARC outcomes in relation to frailty prevented meta-analysis.
Conclusions: Frailty assessment in an already vulnerable TAVI population detects those at highest risk of poor outcomes, with a greater than doubling of early and late mortality. Objective assessment of frailty may inform patient selection for TAVI and should be further studied in large registries.
ACC.i2 Interventional Cardiology PREOPERATIVE FRAILTY AS A PREDICTOR OF OUTCOMES FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Abstract Category: 5. ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Presentation Number: 1144-180 Authors: Atul Anand, Catherine Harley, Akila Visvanathan, Anoop Shah, Joanna Cowell, Alasdair MacLullich, Susan Shenkin, Nicholas Mills, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom Background: Current surgical prognostic calculators do not capture the risk for older patients undergoing transcatheter aortic valve implantation (TAVI). We assessed whether frailty, a reflection of physiological reserve, may be a better determinant in this population.
Methods: We conducted a systematic review of evidence published between 1st January 2000 and 30th May 2015 using the key search terms of frailty (and synonyms) and TAVI (and synonyms). Studies met the inclusion criteria by reporting: 1) any operationalised measure of frailty, and 2) post-TAVI early (≤30 days) or late (>30 days) mortality and procedural complications as defined by the Vascular Academic Research Consortium (VARC).
Results: Ten observational cohort studies (n=4,592) met the inclusion criteria. Frailty was associated with higher early mortality in four studies (n=1,900, HR 2.35, 95% CI 1.78-3.09, p<0.001), and increased late mortality in seven studies (n=3,159, HR 1.72, 95% CI 1.402.12, p<0.001)(see Figure). Use of objective tools to determine frailty identified those at even higher risk of late mortality (HR 2.63, 95% CI 1.87-3.70, p<0.001). Limited reporting of VARC outcomes in relation to frailty prevented meta-analysis.
Conclusions: Frailty assessment in an already vulnerable TAVI population detects those at highest risk of poor outcomes, with a greater than doubling of early and late mortality. Objective assessment of frailty may inform patient selection for TAVI and should be further studied in large registries.