Table 2. Impact of frailty on mortality in selected studies.
| Study | Number of
patients |
TAVR
patients |
Design | Frailty scales | Outcome | ||
| Thirty-day mortality | One-year mortality | Long-term mortality | |||||
| *Presented as estimated using EFT in TAVR and surgical aortic valve replacement cohorts.**Presented as estimated using EFT in TAVR cohort. ***Presented as frailty index combined with EUROSCORE. ****Presented as frailty index combined with STS score. ADL: activities of daily living; BADL: basic activity of daily living; BMI: body mass index; CI: confidence interval; EFT: essential frailty toolset; HR: hazard ratio; IADL: instrumental activities of daily living; LR: likelihood ratio; MMSE: mini-mental state examination; MNA: mini-nutritional assessment; NCT: national clinical trial; NRI: net reclassification improvement; OCEAN-TAVI: Optimized CathEtervAlvulariNtervention-TAVR; OR: odds ratio; PARTNER: placement of aortic transcatheter valves; SPPB: short physical performance battery; STS: Society of Thoracic Surgeons; TAVR: transcatheter aortic valve replacement; TUG: time up and go; TVT: transcatheter valve therapy registry; 5MGS: 5-m gait speed. | |||||||
| Afilalo, et al.[10] | 1,020 | 646 | Prospective multicenter cohort | Fried, Fried+, SPPB, Rockwood, Bern, Columbia, EFT | OR = 3.29*, 95% CI: 1.73–6.26 | OR = 3.19**, 95% CI: 2.03–5.02 | |
| Shimura, et al.[22] | 1,215 | 1,215 | Multicenter registry (OCEAN-TAVI) | Clinical frailty scale stage | HR = 1.42, 95% CI: 1.04–1.95 | HR = 1.28, 95% CI: 1.10–1.49 | |
| Rogers, et al.[11] | 544 | 544 | Prospective single-center cohort | ≥ 3 out of 5: BMI < 20 kg/m 2, Serum albumin < 3.5 g/dL, Katz index of independence in ADL score ≤ 4/6, Low grip strength, Slow 15-foot walk time | OR = 5.06, 95% CI: 1.36–18.8; NRI = 73%, 95% CI: 31–41.1 (after adding frailty to STS prediction model) | OR = 2.75, 95% CI: 1.55–4.87; NRI = 52.7%, 95% CI: 28–77 (after adding frailty to STS prediction model) | |
| Schoenenberger, et al.[23] | 330 | 330 | Prospective single-center cohort | MMSE, TUG, MNA, BADL, IADL, MOBILITY DISABILITY | HR = 3.29, 95% CI: 1.98–5.47; LR chi-square test statistic = 38.27, C-statistic = 0.72, P < 0.001 ***; LR chi-square test statistic = 28.71, C-statistic = 0.68, P < 0.001 **** | ||
| Tang, et al.[26] | 890 | 890 | Retrospective single-center cohort | ≥ 3 out of 5: BMI < 20 kg/m 2, Serum albumin < 3.5 g/dL, Katz index of independence in ADL score ≤ 4/6, Low grip strength, Slow 15-foot walk time | HR = 2.48, 95% CI: 1.79–3.44 | ||
| Steinvi, et al.[27]l | 498 | 498 | Retrospective single-center cohort | ≥ 3 out of 5: BMI < 20 kg/m 2, Serum albumin < 3.5 g/dL, Katz index of independence in ADL score ≤ 4/6, Low grip strength, 5-meter walk test | HR = 2.2, 95% CI: 1.25–3.96 (frailty status); HR = 2.0, 95% CI: 1.08–3.7 (for 3 frailty criteria); HR = 3.07, 95% CI: 1.4–6.7 (for 4–5 frailty criteria) | ||
| Stortecky, et al.[28] | 100 | 100 | Prospective cohort | Bern scale, BADL, IADL, MMSE, MNA, Poor mobility, TUG | OR = 8.33, 95% CI: 0.99–70.48 | OR = 3.68, 95% CI: 1.21–11.19 | |
| Hermiller, et al.[29] | 2,482
(derivation cohort) |
2,482
(derivation cohort) |
Secondary analysis of Core Valve Trial (NCT01240902) | 5MGS, Albumin, Assisted living, BADL, Falls, Grip strength, MMSE, Weight loss | HR = 1.60, 95% CI: 1.04–2.47 (Albumin < 3.3 g/dL); HR = 1.68, 95% CI: 1.05–2.69 (Assisted living);
HR = 1.82, 95% CI: 1.17–2.82 (Katz ADL ≥ 2 deficits) |
HR = 1.94, 95% CI: 1.54–2.45 (Katz ADL ≥ 2 deficits); HR = 1.90, 95% CI: 1.52–2.38 (Assisted living); HR = 1.40, 95% CI: 1.04–1.91 (Albumin < 3.3 g/dL); HR = 1.43, 95% CI: 1.10–1.85 (Weight loss); HR = 1.36, 95% CI: 1.03–1.81 (Falls); HR = 1.26, 95% CI: 1.03–1.55 (Grip strength); HR = 1.42, 95% CI: 1.06–1.91 (5MGS); | |
| Green, et al.[30] | 244 | 244 | Secondary analysis of PARTNER trial (NCT00530894) | Albumin, Grip strength, Gait speed, Katz ADL | HR = 2.5, 95% CI: 1.40–4.35 | ||
| Arnold, et al.[31] | 8,039 | 8,039 | Observational cohort from the STS/ACC TVT Registry | 5MGS | OR = 1.11, 95% CI: 1.01–1.22 | ||
| Puls, et al.[34] | 300 | 300 | Prospective single-center cohort | Katz ADL < 6 | HR = 2.67, 95% CI: 1.7–4.3 | ||
| Van Mourik,
et al.[24] |
5,876
(9 studies) |
5,876
(9 studies) |
Meta-analysis | Different frailty scales among the included studies | HR = 2.16, 95% CI: 1.57–3.00 | ||
| Anand, et al.[25] | 1,900
(4 studies) |
1,900
(4 studies) |
Meta-analysis | Four studies using objective frailty assessment | HR = 2.35, 95% CI: 1.78–3.09 | ||
| Anand, et al.[25] | 3,159
(7 studies) |
3,159
(7 studies) |
Meta-analysis | Seven studies using objective frailty assessment | HR = 1.63, 95% CI: 1.34–1.97 | ||