Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation

• DOI: 10.1093/ageing/afaa071
• Publication Date: 2020-04-05T11:07:29Z
• Authors: Jeannette A Goudz...; Marjo J A G de Ro...; Fleurance E D van...; Eline H C Kwekkeboom; Mattie J Lenzen; Maarten P H van W...; Joris F W Ooms; Rutger-Jan Nuis; Nicolas M Van Mie...; Joost Daemen; Peter P T de Jaegere; Francesco U S Mat...
• Keywords: Frailty; Frail Elderly; Aortic Valve Stenosis; 3. Good health; Transcatheter Aortic Valve Replacement; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Risk Factors; Aortic Valve; Quality of Life; Humans; Prospective Studies; EMC COEUR-09; Research Paper; Aged

Abstract

Background Transcatheter aortic valve implantation (TAVI) brings symptom relief and improvement in health-related quality of life (HRQoL) in the majority of patients treated for symptomatic, severe aortic stenosis. However, there is a substantial group of patients that do not benefit from TAVI. The aim of this study is to investigate the impact of frailty on HRQoL 1 year after TAVI.

Methods The TAVI Care & Cure Program is an ongoing, prospective, observational study including patients referred for TAVI to our institution. A comprehensive geriatric assessment was performed to evaluate existence of frailty using the Erasmus Frailty Score (EFS). HRQoL was assessed using the EQ-5D-5 L at baseline and 1 year after TAVI.

Results 239 patients underwent TAVI and completed HRQoL assessment 1 year after TAVI. Seventy (29.3%) patients were classified as frail (EFS ≥ 3). In non-frail patients, the EQ-5D-5 L index did not change (0.71(± 0.22) to 0.68(± 0.33) points, P = 0.22); in frail patients, the EQ-5D-5 L index decreased from 0.55(±0.26) to 0.44 points (±0.33) (P = 0.022). Frailty was an independent predictor of deteriorated HRQoL 1 year after TAVI (OR 2.24, 95% CI 1.07–4.70, P = 0.003). In frail patients, the absence of peripheral artery disease (OR 0.17, 95% 0.05–0.50, P = 0.001) and renal dysfunction (OR 0.13, 95% CI 0.04–0.41, P = <0.001) at baseline was associated with improved HRQoL 1 year after TAVI.

Conclusion Frailty is associated with deterioration of HRQoL 1 year after TAVI. Notably, HRQoL did improve in frail patients with no peripheral arterial disease or renal impairment at baseline.