Among Frailty Indexes, Poor Mobility Shown to Be Best Predictor of Adverse Outcomes in TAVR

July 10, 2015—James Cockburn, MD, et al published findings from an examination of multiple frailty indexes as markers of performance to see whether they predict outcomes both in the shorter (30 days) and longer (5 years) terms in patients who have undergone transcatheter aortic valve replacement (TAVR). The study is available online ahead of print in Catheterization and Cardiovascular Interventions.

According to the investigators, surgical risk scoring systems are poor at predicting outcomes in patients undergoing TAVR, and frailty indexes might more accurately predict outcomes. The study evaluated the following frailty indexes: mobility, Brighton Mobility Index, New York Heart Association, Karnofsky Performance Index, Canadian Study Health Association clinical frailty scale, and Katz Index of Dependence. Mortality tracking was obtained from the Office of National Statistics as of May 2014.

The study found that poor mobility predicts worse survival among patients undergoing TAVR, both in the shorter and longer terms. The data suggest that mobility impairment, of either neurological or musculoskeletal etiology, is an appropriate screening measure when considering patients for TAVR, concluded the investigators.

As summarized in Catheterization and Cardiovascular Interventions, the investigators assessed frailty indexes in 312 consecutive TAVR patients with a mean age of 81.2 ± 7 years; 53.2% of patients were men. Mean logistic EuroSCORE and Society of Thoracic Surgeons mortality risk score were 17.4 ± 9.4 and 4.6 ± 2.8, respectively. Mean peak aortic valve gradient and aortic valve area were 79.1 ± 28 mm Hg and 0.72 ± 0.25 cm², respectively.

Thirty-day mortality was 4.8%, and long-term mortality (maximum, 5.8 years; mean, 2.2 ± 1.5 years) was 25.3%. Both univariate and multivariate analyses confirmed poor mobility, defined as severe impairment of mobility secondary to musculoskeletal or neurological dysfunction (EuroSCORE II risk), as the best predictor of adverse outcomes over both the short-term of 30 days (odds ratio, 4.03; 95% confidence interval, 1.36–11.96; P = .012) and the longer term of 2.2 ± 1.5 years (odds ratio, 2.15; 95% confidence interval, 1.33–3.48; P = .002), reported the investigators in Catheterization and Cardiovascular Interventions.