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Essential Frailty Toolset Best Predictor of Outcomes After Valve Replacement

July 17, 2017

By Reuters Staff

NEW YORK (Reuters Health) - The Essential Frailty Toolset (EFT) outperforms other frailty scales in assessing the risk of death or disability after transcatheter valve replacement (TAVR) or surgical aortic valve replacement (SAVR), according to new findings.

Guidelines recommend objectively evaluating frailty in patients who are candidates for valve replacement, but there is no universally accepted tool for assessing frailty, Dr. Jonathan Afilalo of Jewish General Hospital and McGill University in Montreal and colleagues write in their report, published online July 7 in the Journal of the American College of Cardiology.

While gait speed is the test used most often to identify frail patients, they add, “characterization of frailty with gait speed alone lacks specificity to discriminate between complex patients who may or may not experience poor outcomes following TAVR or SAVR.”

The researchers compared the predictive value of seven different multidomain frailty scales in 1,020 patients undergoing TAVR or SAVR at 14 centers in three countries in 2012-2016. In addition to the EFT, scales included Fried, Fried+, Rockwood Clinical Frailty Scale (CFS), Short Physical Performance Battery (SPPB), Bern and Columbia.

Patients’ median age was 82, with a range of 77 to 86.

Fourteen percent of the patients died within a year of the procedure. Frailty prevalence ranged from 26% with the CFS to 68% with the SPPB.

EFT, which is based on lower-extremity weakness, cognitive impairment, anemia and hypoalbuminemia, was the strongest predictor of one-year mortality (adjusted odds ratio 3.72), worsening disability at one year (aOR 2.13), and death at 30 days (aOR 3.29). The EFT had the largest C-statistic improvement of 0.071, and was the only scale consistently predictive of treatment futility.

“The advantages of the EFT, beyond its predictive value, are that it is quick to perform, it does not require specialized equipment, and, importantly, its components have high interobserver reliability and are actionable,” Dr. Afilalo and his colleagues write.

“Although the EFT is not all-encompassing, it is a well-rooted starting point to test for frailty, and to identify patients in whom further geriatric assessment should be considered to confirm the diagnoses of sarcopenia, malnutrition, depression, or disability,” they conclude.

Dr. Afilalo was not available for an interview by press time.


J Am Coll Cardiol 2017.

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