Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis
Objectives Assessment of frailty prior to aortic valve intervention is recommended in European and North American valvular heart disease guidelines. However, there is a lack of consensus on how it is best measured. The Clinical Frailty Scale (CFS) is a well-validated measure of frailty that is relat...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-11-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/10/2/e002354.full |
| _version_ | 1797366996401127424 |
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| author | Glen Philip Martin Mamas Mamas Rose Galvin Ahmed Gabr Margaret O’Connor Aoife Leahy Elaine Shanahan Jonathan Afilalo Ivan P Casserly Tadhg Prendiville Anastasia Saleh Fayeza Ahmad Abdirahman Mohamed |
| author_facet | Glen Philip Martin Mamas Mamas Rose Galvin Ahmed Gabr Margaret O’Connor Aoife Leahy Elaine Shanahan Jonathan Afilalo Ivan P Casserly Tadhg Prendiville Anastasia Saleh Fayeza Ahmad Abdirahman Mohamed |
| author_sort | Glen Philip Martin |
| collection | DOAJ |
| description | Objectives Assessment of frailty prior to aortic valve intervention is recommended in European and North American valvular heart disease guidelines. However, there is a lack of consensus on how it is best measured. The Clinical Frailty Scale (CFS) is a well-validated measure of frailty that is relatively quick to calculate. This meta-analysis sought to examine whether the CFS predicts mortality and morbidity following either transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).Methods Nine electronic databases were searched systematically for data on clinical outcomes post-TAVI/SAVR, where patients had undergone preoperative frailty assessment using the CFS. The primary endpoint was 12-month mortality. TAVI and SAVR data were assessed and reported separately. For each individual study, the incidence of adverse outcomes was extracted according to a CFS score of 5–9 (ie, frail) versus 1–4 (ie, non-frail), with meta-analysis performed using a random effects model.Results Of 2612 records screened, nine were included in the review (five TAVI, three SAVR and one which included both interventions). Among 4923 TAVI patients, meta-analysis showed 12-month mortality rates of 19.1% for the frail cohort versus 9.8% for the non-frail cohort (RR 2.53 (1.63 to 3.95), p<0.001, I2=83%). For the smaller cohort of SAVR patients (n=454), mortality rates were 20.3% versus 3.9% for the frail and non-frail cohorts, respectively (RR 5.08 (2.31 to 11.15), p<0.001, I2=5%).Conclusions Frailty, as determined by the CFS, was associated with an increased mortality risk in the 12 months following either TAVI or SAVR. These data would support its use in the preoperative assessment of elderly patients undergoing aortic valve interventions. |
| first_indexed | 2024-03-08T17:11:33Z |
| format | Article |
| id | doaj.art-21d0d81d2122464091ac48883475de40 |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-03-08T17:11:33Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-21d0d81d2122464091ac48883475de402024-01-03T20:20:08ZengBMJ Publishing GroupOpen Heart2053-36242023-11-0110210.1136/openhrt-2023-002354Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysisGlen Philip Martin0Mamas Mamas1Rose Galvin2Ahmed Gabr3Margaret O’Connor4Aoife Leahy5Elaine Shanahan6Jonathan Afilalo7Ivan P Casserly8Tadhg Prendiville9Anastasia Saleh10Fayeza Ahmad11Abdirahman Mohamed12Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UKKeele University, Keele, UKSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, IrelandDepartment of Ageing and Therapeutics, University Hospital Limerick, Limerick, IrelandDepartment of Ageing and Therapeutics, University Hospital Limerick, Limerick, IrelandDepartment of Ageing and Therapeutics, University Hospital Limerick, Limerick, IrelandDepartment of Ageing and Therapeutics, University Hospital Limerick, Limerick, IrelandDivision of Cardiology and Centre of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Québec, CanadaDepartment of Cardiology, Mater Misericordiae University Hospital, Dublin, IrelandDepartment of Cardiology, Cork University Hospital, Cork, IrelandDepartment of Ageing and Therapeutics, University Hospital Limerick, Limerick, IrelandDivision of Cardiology and Centre of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Québec, CanadaDepartment of Ageing and Therapeutics, University Hospital Limerick, Limerick, IrelandObjectives Assessment of frailty prior to aortic valve intervention is recommended in European and North American valvular heart disease guidelines. However, there is a lack of consensus on how it is best measured. The Clinical Frailty Scale (CFS) is a well-validated measure of frailty that is relatively quick to calculate. This meta-analysis sought to examine whether the CFS predicts mortality and morbidity following either transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).Methods Nine electronic databases were searched systematically for data on clinical outcomes post-TAVI/SAVR, where patients had undergone preoperative frailty assessment using the CFS. The primary endpoint was 12-month mortality. TAVI and SAVR data were assessed and reported separately. For each individual study, the incidence of adverse outcomes was extracted according to a CFS score of 5–9 (ie, frail) versus 1–4 (ie, non-frail), with meta-analysis performed using a random effects model.Results Of 2612 records screened, nine were included in the review (five TAVI, three SAVR and one which included both interventions). Among 4923 TAVI patients, meta-analysis showed 12-month mortality rates of 19.1% for the frail cohort versus 9.8% for the non-frail cohort (RR 2.53 (1.63 to 3.95), p<0.001, I2=83%). For the smaller cohort of SAVR patients (n=454), mortality rates were 20.3% versus 3.9% for the frail and non-frail cohorts, respectively (RR 5.08 (2.31 to 11.15), p<0.001, I2=5%).Conclusions Frailty, as determined by the CFS, was associated with an increased mortality risk in the 12 months following either TAVI or SAVR. These data would support its use in the preoperative assessment of elderly patients undergoing aortic valve interventions.https://openheart.bmj.com/content/10/2/e002354.full |
| spellingShingle | Glen Philip Martin Mamas Mamas Rose Galvin Ahmed Gabr Margaret O’Connor Aoife Leahy Elaine Shanahan Jonathan Afilalo Ivan P Casserly Tadhg Prendiville Anastasia Saleh Fayeza Ahmad Abdirahman Mohamed Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis Open Heart |
| title | Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis |
| title_full | Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis |
| title_fullStr | Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis |
| title_full_unstemmed | Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis |
| title_short | Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis |
| title_sort | clinical frailty scale as a predictor of adverse outcomes following aortic valve replacement a systematic review and meta analysis |
| url | https://openheart.bmj.com/content/10/2/e002354.full |
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