A novel geriatric assessment frailty score predicts 2-year mortality after transcatheter aortic valve implantation

Skaar, Elisabeth; Eide, Leslie Sofia Pareja; Norekvål, Tone M.; Ranhoff, Anette Hylen; Nordrehaug, Jan Erik; Forman, Daniel E.; Schoenenberger, Andreas W.; Hufthammer, Karl Ove; Kuiper, Karel Kier-Jan; Bleie, Øyvind; Packer, Erik; Langørgen, Jørund; Haaverstad, Rune; Schaufel, Margrethe Aase

doi:10.1093/ehjqcco/qcy044

Cited by 47 publications

(38 citation statements)

References 55 publications

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“…Specifically related to TAVR, previous studies have examined the value of determining frailty for risk stratification. For example, a study in 2018 showed that 11% patients of average age of 83 died 2 years after TAVR, and a geriatric assessment frailty score cut-off at ≥4 predicted 2-year mortality with a specificity of 80% 21 . Another study showed that 242 out of 544 TAVR patients were frail 1 year after the procedure based on frailty definition 22 .…”

Section: Discussionmentioning

confidence: 99%

Development of an electronic frailty index for predicting mortality in patients undergoing transcatheter aortic valve replacement using machine learning

Chen

Zhou

Lee

et al. 2020

Preprint

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BackgroundElectronic frailty indices can be useful surrogate measures of frailty. We assessed the role of machine learning to develop an electronic frailty index, incorporating demographics, baseline comorbidities, healthcare utilization characteristics, electrocardiographic measurements, and laboratory examinations, and used this to predict all-cause mortality in patients undergoing transaortic valvular replacement (TAVR).MethodsThis was a multi-centre retrospective observational study of patients undergoing for TAVR. Significant univariate and multivariate predictors of all-cause mortality were identified using Cox regression. Importance ranking of variables was obtained with a gradient boosting survival tree (GBST) model, a supervised sequential ensemble learning algorithm, and used to build the frailty models. Comparisons were made between multivariate Cox, GBST and random survival forest models.ResultsA total of 450 patients (49% females; median age at procedure 82.3 (interquartile range, IQR 79.0-86.0)) were included, of which 22 died during follow-up. A machine learning survival analysis model found that the most important predictors of mortality were APTT, followed by INR, severity of tricuspid regurgitation, cumulative hospital stays, cumulative number of readmissions, creatinine, urate, ALP, and QTc/QT intervals. GBST significantly outperformed random survival forests and multivariate Cox regression (precision: 0.91, recall: 0.89, AUC: 0.93, C-index: 0.96, and KS-index: 0.50) for mortality prediction.ConclusionsAn electronic frailty index incorporating multi-domain data can efficiently predict all-cause mortality in patients undergoing TAVR. A machine learning survival learning model significantly improves the risk prediction performance of the frailty models.

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Section: Discussionmentioning

confidence: 99%

Development of an electronic frailty index for predicting mortality in patients undergoing transcatheter aortic valve replacement using machine learning

Chen

Zhou

Lee

et al. 2020

Preprint

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“…The research team developed an 8-item frailty scale [ 14 ]. The total score is calculated by adding different domain scores: cognition (MMSE ≥ 27 = 0 points, MMSE 20–26 = 1 point, MMSE ≤ 19 = 2 points), instrumental activity of daily living (NEADL ≤ 43 = 1 point), nutrition (BMI < 20.5 = 1 point), modified SOF (low energy = 1 point, weight loss (reported, not measured weight loss; therefore, modified) = 1 point, chair stand, not able = 1 point) [ 15 ], Charlson Comorbidity Index (≥ 3 = 1 point) [ 16 ], and psychological factors (HADS ≥ 15 = 1 point) [ 17 ].…”

Section: Measurementsmentioning

confidence: 99%

“…This cut-off had a specificity of 80% and sensitivity of 60% at predicting 2-year mortality for this population. In a receiver operating curve, the area under the curve was 0.81 (95% confidence interval 0.71–0.90) [ 14 ].…”

Section: Measurementsmentioning

confidence: 99%

Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study

et al. 2020

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Aims The objective of this study was to examine baseline frailty status (including cognitive deficits) and important clinical outcomes, to inform shared decision-making in older adults receiving transcatheter aortic valve implantation (TAVI). Methods and resultsWe conducted a prospective, observational study of 82 TAVI patients, recruited 2013 to 2015, with 2-year follow-up. Mean age was 83 years (standard deviation (SD) 4.7). Eighteen percent of the patients were frail, as assessed with an 8-item frailty scale. Fifteen patients (18%) had a Mini-Mental Status Examination (MMSE) score below 24 points at baseline, indicating cognitive impairment or dementia and five patients had an MMSE below 20 points. Mean New York Heart Association (NYHA) class at baseline and 6 months was 2.5 (SD 0.6) and 1.4 (SD 0.6), (p < 0.001). There was no change in mean Nottingham Extended Activities of Daily Living (NEADL) scale between baseline and 6 months, 54.2 (SD 11.5) and 54.5 (SD 10.3) points, respectively, mean difference 0.3 (p = 0.7). At 2 years, six patients (7%) had died, four (5%, n = 79) lived in a nursing home, four (5%) suffered from disabling stroke, and six (7%) contracted infective endocarditis. Conclusions TAVI patients had improvement in symptoms and maintenance of activity of daily living at 6 months. They had low mortality and most patients lived in their own home 2 years after TAVI. Complications like death, stroke, and endocarditis occurred. Some patients had cognitive impairment before the procedure which might influence decision-making. Our findings may be used to develop pre-TAVI decision aids.

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“…Trans-catheter aortic valve implantation (TAVI) has been a standard therapy for severe aortic valve stenosis (AS), especially in high surgical risk patients [ 1 – 4 ]. Frailty, lower active daily life (ADL), or malnutrition have been reported as major predictors of poor long-term outcomes after TAVI [ 5 – 9 ]. Moreover, symptomatic AS was associated with poor clinical outcomes [ 10 ], whereas asymptomatic AS was associated with favorable clinical outcomes [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of long-term outcomes after trans-catheter aortic valve implantation between patients primarily diagnosed by cardiac murmur and those diagnosed by other reasons

et al. 2021

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Careful auscultation is the first step to diagnose aortic stenosis (AS). The aim of this study was to compare clinical outcomes following transcatheter aortic valve implantation (TAVI) between the patients primarily diagnosed by heart murmur and those diagnosed by other reasons. We retrospectively included 258 patients who underwent TAVI in our medical center, and divided those into the murmur group (n = 81) and the other-reason group (n = 177) according to the primary reason for AS diagnosis. The primary endpoint was the major adverse cardiovascular and cerebrovascular events (MACCE), which was defined as the composite of cardiovascular death, hospitalization due to acute decompensated heart failure, and disabling stroke. The murmur group included younger patients than the other-reason group (82.8 year-old vs. 84.0 year-old, P = 0.02). History of AF was more frequently observed in the other-reason group than in the murmur group (21.5% vs. 7.4%, P <0.01). STS score and logistic EuroSCORE were lower in the murmur group than in the other-reason group (STS: 4.7% vs. 7.2%, P <0.01, logistic EuroSCORE: 8.3% vs. 11.2%, P <0.01). The median follow-up period was 562 days. MACCE was more frequently observed in the other-reason group than in the murmur group (27.7% vs. 9.9%, Log Rank P <0.01). The multivariate COX hazard analysis revealed that the AS patients primarily diagnosed by heart murmur was inversely associated with MACCE (HR 0.38, 95%CI 0.17–0.86, P = 0.020). Among AS patients who underwent TAVI, the patients primarily diagnosed by heart murmur were significantly associated with favorable long-term clinical outcomes.

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A novel geriatric assessment frailty score predicts 2-year mortality after transcatheter aortic valve implantation

Abstract: A novel 8-element GA frailty score identified gradations in survival in patients declined for open heart surgery. Patients with higher GA frailty scores had significantly higher two-year mortality after TAVI.

Cited by 47 publications

References 55 publications

Development of an electronic frailty index for predicting mortality in patients undergoing transcatheter aortic valve replacement using machine learning

Development of an electronic frailty index for predicting mortality in patients undergoing transcatheter aortic valve replacement using machine learning

Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study

Comparison of long-term outcomes after trans-catheter aortic valve implantation between patients primarily diagnosed by cardiac murmur and those diagnosed by other reasons

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