Frailty Status and Outcomes after Transcatheter Aortic Valve Implantation

Chetan P. Huded, Jill M. Huded, Julie L. Friedman, Lillian R. Benck, Lee A Lindquist, Thomas A Holly, Ranya Nabil Sweis, Mark J Ricciardi, S Chris Malaisrie, Charles J Davidson, James D Flaherty*

*Corresponding author for this work

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Frailty is a syndrome of older adults associated with increased morbidity and mortality. We aimed to assess the impact of frailty status on outcomes after transcatheter aortic valve implantation (TAVI). We reviewed all 191 patients who underwent a modified Fried frailty assessment before TAVI between February 2012 and September 2015 at a single academic medical center, and we assessed the impact of preoperative frailty status on morbidity, mortality, and health care utilization after TAVI. Frailty, pre-frailty, and nonfrailty were present in 33% (n = 64), 37% (n = 70), and 30% (n = 57) of patients, respectively. Slowness (75% vs 54%, p = 0.003) and low physical activity (55% vs 31%, p = 0.001) were more common in women than men. With increasing frailty status, the proportion of women increased (35% nonfrail, 44% pre-frail, and 66% frail, p = 0.002) and stature decreased (1.68 ± 0.11 m nonfrail, 1.66 ± 0.11 m pre-frail, 1.62 ± 0.12 m frail, p = 0.028). There was no difference in post-TAVI 30-day mortality, stroke, major vascular injury, major or life-threatening bleeding, respiratory failure, mean hospital length of stay, 30-day hospital re-admission, or overall survival between groups. The rate of discharge to a rehabilitation facility increased with increasing frailty status (14% nonfrail, 22% pre-frail, and 39% frail, p = 0.005). Frailty was independently associated with discharge to a rehabilitation facility (odds ratio 4.80, 95% confidence interval 1.66 to 13.85, p = 0.004). In conclusion, the safety of TAVI is not affected by frailty status, but patients with frailty are less likely to be discharged directly home after TAVI.

Original languageEnglish (US)
Pages (from-to)1966-1971
Number of pages6
JournalAmerican Journal of Cardiology
Volume117
Issue number12
DOIs
StatePublished - Jun 15 2016

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Mortality
Length of Stay
Rehabilitation
Patient Acceptance of Health Care
Morbidity
Vascular System Injuries
Respiratory Insufficiency
Transcatheter Aortic Valve Replacement
Stroke
Odds Ratio
Confidence Intervals
Exercise
Hemorrhage
Safety
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{37a37c92052b4d96977ec246b725f418,
title = "Frailty Status and Outcomes after Transcatheter Aortic Valve Implantation",
abstract = "Frailty is a syndrome of older adults associated with increased morbidity and mortality. We aimed to assess the impact of frailty status on outcomes after transcatheter aortic valve implantation (TAVI). We reviewed all 191 patients who underwent a modified Fried frailty assessment before TAVI between February 2012 and September 2015 at a single academic medical center, and we assessed the impact of preoperative frailty status on morbidity, mortality, and health care utilization after TAVI. Frailty, pre-frailty, and nonfrailty were present in 33{\%} (n = 64), 37{\%} (n = 70), and 30{\%} (n = 57) of patients, respectively. Slowness (75{\%} vs 54{\%}, p = 0.003) and low physical activity (55{\%} vs 31{\%}, p = 0.001) were more common in women than men. With increasing frailty status, the proportion of women increased (35{\%} nonfrail, 44{\%} pre-frail, and 66{\%} frail, p = 0.002) and stature decreased (1.68 ± 0.11 m nonfrail, 1.66 ± 0.11 m pre-frail, 1.62 ± 0.12 m frail, p = 0.028). There was no difference in post-TAVI 30-day mortality, stroke, major vascular injury, major or life-threatening bleeding, respiratory failure, mean hospital length of stay, 30-day hospital re-admission, or overall survival between groups. The rate of discharge to a rehabilitation facility increased with increasing frailty status (14{\%} nonfrail, 22{\%} pre-frail, and 39{\%} frail, p = 0.005). Frailty was independently associated with discharge to a rehabilitation facility (odds ratio 4.80, 95{\%} confidence interval 1.66 to 13.85, p = 0.004). In conclusion, the safety of TAVI is not affected by frailty status, but patients with frailty are less likely to be discharged directly home after TAVI.",
author = "Huded, {Chetan P.} and Huded, {Jill M.} and Friedman, {Julie L.} and Benck, {Lillian R.} and Lindquist, {Lee A} and Holly, {Thomas A} and Sweis, {Ranya Nabil} and Ricciardi, {Mark J} and Malaisrie, {S Chris} and Davidson, {Charles J} and Flaherty, {James D}",
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Frailty Status and Outcomes after Transcatheter Aortic Valve Implantation. / Huded, Chetan P.; Huded, Jill M.; Friedman, Julie L.; Benck, Lillian R.; Lindquist, Lee A; Holly, Thomas A; Sweis, Ranya Nabil; Ricciardi, Mark J; Malaisrie, S Chris; Davidson, Charles J; Flaherty, James D.

In: American Journal of Cardiology, Vol. 117, No. 12, 15.06.2016, p. 1966-1971.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Frailty Status and Outcomes after Transcatheter Aortic Valve Implantation

AU - Huded, Chetan P.

AU - Huded, Jill M.

AU - Friedman, Julie L.

AU - Benck, Lillian R.

AU - Lindquist, Lee A

AU - Holly, Thomas A

AU - Sweis, Ranya Nabil

AU - Ricciardi, Mark J

AU - Malaisrie, S Chris

AU - Davidson, Charles J

AU - Flaherty, James D

PY - 2016/6/15

Y1 - 2016/6/15

N2 - Frailty is a syndrome of older adults associated with increased morbidity and mortality. We aimed to assess the impact of frailty status on outcomes after transcatheter aortic valve implantation (TAVI). We reviewed all 191 patients who underwent a modified Fried frailty assessment before TAVI between February 2012 and September 2015 at a single academic medical center, and we assessed the impact of preoperative frailty status on morbidity, mortality, and health care utilization after TAVI. Frailty, pre-frailty, and nonfrailty were present in 33% (n = 64), 37% (n = 70), and 30% (n = 57) of patients, respectively. Slowness (75% vs 54%, p = 0.003) and low physical activity (55% vs 31%, p = 0.001) were more common in women than men. With increasing frailty status, the proportion of women increased (35% nonfrail, 44% pre-frail, and 66% frail, p = 0.002) and stature decreased (1.68 ± 0.11 m nonfrail, 1.66 ± 0.11 m pre-frail, 1.62 ± 0.12 m frail, p = 0.028). There was no difference in post-TAVI 30-day mortality, stroke, major vascular injury, major or life-threatening bleeding, respiratory failure, mean hospital length of stay, 30-day hospital re-admission, or overall survival between groups. The rate of discharge to a rehabilitation facility increased with increasing frailty status (14% nonfrail, 22% pre-frail, and 39% frail, p = 0.005). Frailty was independently associated with discharge to a rehabilitation facility (odds ratio 4.80, 95% confidence interval 1.66 to 13.85, p = 0.004). In conclusion, the safety of TAVI is not affected by frailty status, but patients with frailty are less likely to be discharged directly home after TAVI.

AB - Frailty is a syndrome of older adults associated with increased morbidity and mortality. We aimed to assess the impact of frailty status on outcomes after transcatheter aortic valve implantation (TAVI). We reviewed all 191 patients who underwent a modified Fried frailty assessment before TAVI between February 2012 and September 2015 at a single academic medical center, and we assessed the impact of preoperative frailty status on morbidity, mortality, and health care utilization after TAVI. Frailty, pre-frailty, and nonfrailty were present in 33% (n = 64), 37% (n = 70), and 30% (n = 57) of patients, respectively. Slowness (75% vs 54%, p = 0.003) and low physical activity (55% vs 31%, p = 0.001) were more common in women than men. With increasing frailty status, the proportion of women increased (35% nonfrail, 44% pre-frail, and 66% frail, p = 0.002) and stature decreased (1.68 ± 0.11 m nonfrail, 1.66 ± 0.11 m pre-frail, 1.62 ± 0.12 m frail, p = 0.028). There was no difference in post-TAVI 30-day mortality, stroke, major vascular injury, major or life-threatening bleeding, respiratory failure, mean hospital length of stay, 30-day hospital re-admission, or overall survival between groups. The rate of discharge to a rehabilitation facility increased with increasing frailty status (14% nonfrail, 22% pre-frail, and 39% frail, p = 0.005). Frailty was independently associated with discharge to a rehabilitation facility (odds ratio 4.80, 95% confidence interval 1.66 to 13.85, p = 0.004). In conclusion, the safety of TAVI is not affected by frailty status, but patients with frailty are less likely to be discharged directly home after TAVI.

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