Frailty Assessed by the Forecast is a Valid Tool to Predict Short-Term Outcome after Transcatheter Aortic Valve Replacement

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The term frailty is frequently used during decision-making in transcatheter heart valve procedures. Nevertheless, frailty is still measured by eyeballing rather than by using standardized frailty assessments. In a previous study, we developed a frailty score in a cardiac surgical patient population including patients, who underwent transcatheter aortic valve replacement (TAVR). Here, we present the results from the subsequent validation study focusing on the TAVR cohort. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> One hundred thirty patients underwent TAVR. Frailty assessment using the FORECAST (Frailty predicts death One yeaR after Elective CArdiac Surgery Test) was performed. The European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons (STS) score were assessed as well. Follow-up included assessment of in-hospital and 30-day mortality and morbidity and quality of life using the Short Form-36 questionnaire. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Mean age was 83.3 years, and 50% were female. Logistic European System for Cardiac Operative Risk Evaluation was 14.9 ± 8.7%, and STS score was 5.1 ± 3.4%. Mean ± standard deviation FORECAST score was 4.8 ± 3.3 points of 15. In-hospital and 30-day mortality were 6.9% and 7.7%, respectively. Thirty-day Short Form-36 assessment showed a decrease in quality of life in five of ten items after the intervention. Receiver operating characteristic curves showed that the FORECAST is a valid tool to predict in-hospital mortality (area under the receiver operating characteristic curve, 0.73). By combining the FORECAST and the STS score, this effect was even higher (area under the receiver operating characteristic curve, 0.77; P = 0.021). Stratifying the patients according to the FORECAST score showed best survival in the lowest frailty group. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> The FORECAST is a valid tool to assess frailty in TAVR patients. The FORECAST is easily assessable and can be included in daily clinical routine. </jats:p></jats:sec>

Multicomponent Frailty Assessment Tools for Older People with Psychiatric Disorders: A Systematic Review

“…Forty‐eight multicomponent frailty assessment tools were examined across 95 studies . The most frequently observed study design was prospective cohort (32 of 95 studies) 3,9,40–44,46–49,57,68–70,72,73,78,80,84,87,89,92,95,97,101,105,107,114,116,129,130 . Of the 62 studies with follow‐up data available, follow‐up periods ranged from 1 month to 348 months .…”

“…The most frequently observed study design was prospective cohort (32 of 95 studies) 3,9,40–44,46–49,57,68–70,72,73,78,80,84,87,89,92,95,97,101,105,107,114,116,129,130 . Of the 62 studies with follow‐up data available, follow‐up periods ranged from 1 month to 348 months . The total number of participants per study ranged from 14 to 931 541 .…”

“…A further 7 of 95 studies had at least one aspect of methodological quality rated as good; hypothesis testing was the measurement property with the highest number of good ratings (4 of 7). Overall, 70 of 95 studies had at least one aspect of methodological quality rated as fair 3,9,26,27,40,42,43,45,46,49–58,60,62,64,67–70,72–75,79–85,87–97,99–101,104,105,107–116,118,122,123,125–127 . Hypothesis testing had the greatest number of fair ratings (65 of 70).…”

“…Table provides an overview of construct overlap observed in relation to frailty assessment domains, and Supplementary Table 3 provides an overview of all construct overlap observed. Of the tools reviewed, only 7 of 48 had no definite construct overlap between frailty assessment tool items and DSM‐5 diagnostic criteria for MDD, BAD, schizophrenia, GAD, SAD, SP, or PD: Brief Clinical Instrument to Classify Frailty, the Clinical Frailty Scale (CFS), Frailty Predicts Death 1 Yea After Cardiac Surgery Test (FORECAST), Frailty Index Based on Common Laboratory Tests (FI‐LAB), Korean Longitudinal Study of Health and Aging (KLoSHA) Frailty Index, Palumbo Frailty Index, and the 9‐Item Frailty Measure . In 29 of 48 tools, definite construct overlap was established between the nutritive domains of the frailty assessment tool (weight loss/reduced appetite) and DSM‐5 diagnostic criteria for MDD and BAD concerning weight loss and appetite changes 3,9,26,27,41,42,45,50,57,61–65,68–70,74–77,79,80,82–96,98,99,101–104,106,107,109–129 .…”

“…Of the tools reviewed, only 7 of 48 had no definite construct overlap between frailty assessment tool items and DSM‐5 diagnostic criteria for MDD, BAD, schizophrenia, GAD, SAD, SP, or PD: Brief Clinical Instrument to Classify Frailty, the Clinical Frailty Scale (CFS), Frailty Predicts Death 1 Yea After Cardiac Surgery Test (FORECAST), Frailty Index Based on Common Laboratory Tests (FI‐LAB), Korean Longitudinal Study of Health and Aging (KLoSHA) Frailty Index, Palumbo Frailty Index, and the 9‐Item Frailty Measure . In 29 of 48 tools, definite construct overlap was established between the nutritive domains of the frailty assessment tool (weight loss/reduced appetite) and DSM‐5 diagnostic criteria for MDD and BAD concerning weight loss and appetite changes 3,9,26,27,41,42,45,50,57,61–65,68–70,74–77,79,80,82–96,98,99,101–104,106,107,109–129 . Definite construct overlap was observed between frailty items concerning fatigue and the DSM‐5 diagnostic criteria for MDD, BAD, and GAD concerning fatigue in 21 of 48 tools 3,9,26,41,45,50–53,66,67,74–77,79,81,83,85,91,95,101–103,106–116,119–129 .…”