Sandra Shi1, Jonathan Afilalo2, Lewis A Lipsitz1,3, Jeffrey J Popma4, Kamal R Khabbaz5, Roger J Laham4, Kim Guibone4, Francine Grodstein6, Eliah Lux1, Dae Hyun Kim1,7. 1. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 2. Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 3. Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts. 4. Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 5. Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 6. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 7. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: Frailty phenotype and deficit-accumulation frailty index (FI) are widely used measures of frailty. Their performance in predicting recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) has not been compared. METHODS: Patients undergoing SAVR (n = 91) or TAVR (n = 137) at an academic medical center were prospectively assessed for frailty phenotype and FI. Outcomes were death or poor recovery, defined as a decline in ability to perform 22 daily activities and New York Heart Association class 3 or 4 at 6 months after surgery. The predictive ability of frailty phenotype versus FI and their additive value to a traditional surgical risk model were evaluated using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement. RESULTS: TAVR patients had higher prevalence of phenotypic frailty (85% vs 38%, p < .001) and greater mean FI (0.37 vs 0.24, p < .001) than SAVR patients. In the overall cohort, FI had a higher C-statistic than frailty phenotype (0.74 vs 0.63, p = .01) for predicting death or poor recovery. Adding FI to the traditional model improved prediction (NRI, 26.4%, p = .02; integrated discrimination improvement, 7.7%, p < .001), while adding phenotypic frailty did not (NRI, 4.0%, p = .70; integrated discrimination improvement, 1.6%, p = .08). The additive value of FI was evident in TAVR patients (NRI, 42.8%, p < .01) but not in SAVR patients (NRI, 25.0%, p = .29). Phenotypic frailty did not add significantly in either TAVR (NRI, 6.8%, p = .26) or SAVR patients (NRI, 25.0%, p = .29). CONCLUSIONS: Deficit-accumulation FI provides better prediction of death or poor recovery than frailty phenotype in older patients undergoing SAVR and TAVR.
BACKGROUND: Frailty phenotype and deficit-accumulation frailty index (FI) are widely used measures of frailty. Their performance in predicting recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) has not been compared. METHODS:Patients undergoing SAVR (n = 91) or TAVR (n = 137) at an academic medical center were prospectively assessed for frailty phenotype and FI. Outcomes were death or poor recovery, defined as a decline in ability to perform 22 daily activities and New York Heart Association class 3 or 4 at 6 months after surgery. The predictive ability of frailty phenotype versus FI and their additive value to a traditional surgical risk model were evaluated using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement. RESULTS: TAVR patients had higher prevalence of phenotypic frailty (85% vs 38%, p < .001) and greater mean FI (0.37 vs 0.24, p < .001) than SAVR patients. In the overall cohort, FI had a higher C-statistic than frailty phenotype (0.74 vs 0.63, p = .01) for predicting death or poor recovery. Adding FI to the traditional model improved prediction (NRI, 26.4%, p = .02; integrated discrimination improvement, 7.7%, p < .001), while adding phenotypic frailty did not (NRI, 4.0%, p = .70; integrated discrimination improvement, 1.6%, p = .08). The additive value of FI was evident in TAVR patients (NRI, 42.8%, p < .01) but not in SAVR patients (NRI, 25.0%, p = .29). Phenotypic frailty did not add significantly in either TAVR (NRI, 6.8%, p = .26) or SAVR patients (NRI, 25.0%, p = .29). CONCLUSIONS:Deficit-accumulation FI provides better prediction of death or poor recovery than frailty phenotype in older patients undergoing SAVR and TAVR.
Authors: Stefan Stortecky; Andreas W Schoenenberger; André Moser; Bindu Kalesan; Peter Jüni; Thierry Carrel; Seraina Bischoff; Christa-Maria Schoenenberger; Andreas E Stuck; Stephan Windecker; Peter Wenaweser Journal: JACC Cardiovasc Interv Date: 2012-05 Impact factor: 11.195
Authors: Philip Green; Abigail E Woglom; Philippe Genereux; Benoit Daneault; Jean-Michel Paradis; Susan Schnell; Marian Hawkey; Mathew S Maurer; Ajay J Kirtane; Susheel Kodali; Jeffrey W Moses; Martin B Leon; Craig R Smith; Mathew Williams Journal: JACC Cardiovasc Interv Date: 2012-09 Impact factor: 11.195
Authors: Derk Frank; Simon Kennon; Nikolaos Bonaros; Mauro Romano; Thierry Lefèvre; Carlo Di Mario; Pierluigi Stefàno; Flavio Luciano Ribichini; Dominique Himbert; Marina Urena-Alcazar; Jorge Salgado-Fernandez; Jose Joaquin Cuenca Castillo; Bruno Garcia; Jana Kurucova; Martin Thoenes; Claudia Lüske; Peter Bramlage; Rima Styra Journal: Open Heart Date: 2019-05-21