Poor mobility predicts adverse outcome better than other frailty indices in patients undergoing transcatheter aortic valve implantation

Abstract

Poor mobility predicts worse survival among patients undergoing TAVI, both in the shorter and longer terms. Our data suggest that mobility impairment, of either neurological or musculoskeletal etiology, is an appropriate screening measure when considering patients for TAVI.

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

“…We identified 25 studies that evaluated the association of frailty with mortality or functional status at ≥6 months in 18388 patients undergoing major cardiac surgical procedures (9 frailty instruments in 8 studies of CABG or open valve surgery)(41-49) and 5177 patients undergoing minimally invasive cardiac surgical procedures (13 instruments in 17 studies of TAVR)(11-15, 50-61) (Appendix Figure 1). …”

“…A simple assessment of mobility (administration time <1 minute), such as impaired mobility due to musculoskeletal or neurologic disorder(56) or use of assistive devices(50), and 6MWT (10 minutes) distance below various thresholds(12, 51-53) were statistically significantly associated with a 1.2- to 3.2-fold increase in mortality (Table 2). ADL dependence (5 minutes) was statistically significantly associated with mortality in 2 of the 3 studies.…”

“…ADL dependence (5 minutes) was statistically significantly associated with mortality in 2 of the 3 studies. (54, 55) The Clinical Frailty Scale (3 minutes), a global assessment based on medical problems, activity level, and disability, predicted mortality,(50, 60) whereas subjective assessment without such a scale did not. (12, 56, 57) A majority of studies of single-component instruments were conducted in highly representative samples, but the risk of bias was high due to determination of frailty status without using previously validated or clinical cutpoints and lack of validation (Appendix Figure 2 panel A).…”

“…Objective measures of lower extremity performance (mobility and leg muscle strength), such as TUG,(11, 58), 6MWT(12), and chair rise,(48) seemed to have higher C statistics or RRs than cognitive tests,(11, 58) self-reported mobility impairment,(11, 48, 58) disability,(11, 58) or subjective assessment. (12, 48) Among the non-performance-based measures, self-reported mobility impairment, such as stair climbing,(48) preclinical mobility disability,(11, 58) mobility impairment due to musculoskeletal or neurological disorder,(50) and wheelchair use(15), was more predictive than disability,(11, 50, 58) serum albumin,(15) and subjective assessment. (48, 50) In comparing single-component and multi-component frailty instruments, multi-component instruments seemed to provide better prediction as shown by Green et al(14) and Sundermann et al(48) Similarly, the Mini-Nutritional Assessment(62) that considered several risk factors of malnutrition in multiple domains showed higher RR than disability or cognition alone.…”

“…(12, 48) Among the non-performance-based measures, self-reported mobility impairment, such as stair climbing,(48) preclinical mobility disability,(11, 58) mobility impairment due to musculoskeletal or neurological disorder,(50) and wheelchair use(15), was more predictive than disability,(11, 50, 58) serum albumin,(15) and subjective assessment. (48, 50) In comparing single-component and multi-component frailty instruments, multi-component instruments seemed to provide better prediction as shown by Green et al(14) and Sundermann et al(48) Similarly, the Mini-Nutritional Assessment(62) that considered several risk factors of malnutrition in multiple domains showed higher RR than disability or cognition alone. (11, 58) However, a multi-component instrument that was composed of several measures assessing the same domain showed lower C statistic than its abbreviated version.…”