Frailty Measures in Patients Being Evaluated For Trans-Catheter Aortic Valve Replacement: A Retrospective Review

Abstract

Objective: This quality improvement initiative was to 1) profile the frailty indicators in the high-risk patients evaluated for transcatheter aortic valve replacement (TAVR), and 2) determine the relationships between frailty measures and 30-day all-cause mortality as well as hospital length of stay (LOS) post TAVR. Background: Frailty is a geriatric syndrome that is notably common in older patients with severe aortic stenosis (AS). The TAVR is a less invasive treatment option for high-risk surgical candidates or patients who are not deemed operable candidates. Expert guidelines recommend a comprehensive evaluation of high-risk patients with severe AS that includes the assessment of frailty to determine the risk versus benefit of the procedure. Methods: Health records from 50 post-TAVR patients were retrospectively reviewed to abstract the frailty indicators, the Society of Thoracic Surgeons Perioperative Risk of Mortality (STS-PROM) score, the Katz Index of Independence in Activities of Daily Living, as well as outcomes (30-day all-cause mortality and hospital LOS). These patients were consecutively selected from the structural heart team admission registry between February 2018 and July 2019. Results: The median age of the sample was 82 years, and 77% were men. Many frailty measures were unavailable in the health records except for gait speed and laboratory data, such as hemoglobin and serum albumin. There was no 30-day mortality that was related to the TAVR procedure. Univariant analysis showed that gait speed was a significant predictor of hospital LOS. Conclusion: No multivariable frailty assessment tool was used to screen for frailty in these high-risk patients pre-TAVR procedure at the project site; however, patients who underwent TAVR had favorable 30-day all-cause mortality and hospital LOS compared to national metrics. Gait speed, a commonly performed frailty measure, was found to be a significant predictor for hospital LOS. Future research is needed to determine if mobile technology can capture more reliable and valid frailty indicators in patients with severe AS being evaluated for TAVR.