Frailty Status and Patient-Reported Outcomes in Octogenarians Following Transcatheter or Surgical Aortic Valve Replacement

• Published in: Heart, lung & circulation lung & circulation, 2021-08, Vol.30 (8), p.1221-1231
• Main Authors: Frantzen, Astri Tafjord, Eide, Leslie S.P., Fridlund, Bengt, Haaverstad, Rune, Hufthammer, Karl Ove, Kuiper, Karel K.J., Lauck, Sandra, Ranhoff, Anette H., Rudolph, James L., Skaar, Elisabeth, Norekvål, Tone M.
• Format: Article
• Language: English
• Subjects: Aortic valve stenosis; Frailty; Health status; Nursing; Octogenarians; Omvårdnad; Patient-reported outcome measures; Surgical aortic valve replacement; Transcatheter aortic valve implantation
• ISSN: 1443-9506; 1444-2892; 1444-2892
• DOI: 10.1016/j.hlc.2020.10.024

Frailty status and patient-reported outcomes are especially pertinent in octogenarians following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) to guide treatment decisions and promote patient-centred care. We aimed to determine if frailty changed 6 months after aortic valve replacement (AVR) in octogenarians, and to describe changes in self-rated health according to frailty status in patients who underwent TAVI or SAVR. In a prospective cohort study, frailty and self-rated health were measured one day prior to and 6 months after AVR. Frailty status was measured with the Study of Osteoporotic Fracture index. Self-rated health was measured comprehensively with the disease-specific Minnesota Living with Heart Failure Questionnaire, the generic Medical Outcomes Study Short Form-12 questionnaire (SF-12), and two global questions from The World Health Organization Quality of Life Instrument Abbreviated. Data were available for 143 consecutive patients (mean age 83±2.7 years, 57% women; 45% underwent TAVI). At baseline, 34% were robust, 27% prefrail, and 39% frail. Overall, there was no change in the distribution of frailty status 6 months after baseline (p=0.13). However, on an individual level 65 patients changed frailty status after AVR (40 patients improved and 25 declined). Improvement in frailty status was common in prefrail (33%; n=13) and frail patients (48%; n=27). Patients had improved self-rated health after AVR, with significant differences between frailty states both at baseline (SF-12 physical: 37.4 [robust], 33.1 [prefrail], 31.6 [frail], p=0.03); SF-12 mental: 51.9 [robust], 50.8 [prefrail], 44.5 [frail], p