Superiority of the Rockwood Clinical Frailty Scale for Assessing Long-Term Outcome in Patients Undergoing Transcatheter Aortic Valve Implantation.

BACKGROUND

Frailty is associated with poorer short-term outcomes after transcatheter aortic valve implantation (TAVI), and national guidelines recommend an assessment of frailty as part of the decision-making process. However, multiple frailty indices are currently used in clinical practice, and it is unclear which has the best discrimination in TAVI patients and whether this extends into the long term.

AIMS: We therefore aimed to compare three commonly used frailty indices in a large TAVI cohort and examine their ability to predict 5-year outcomes.

METHODS

The study population included 1059 patients from a high-volume UK TAVI center from 2007 to 2019. Data were collected prospectively using a data set recommended by the British Cardiovascular Intervention Society (BCIS). Frailty was assessed using the Rockwood Clinical Frailty Scale (CFS), Karnofsky Performance Index, and the Katz Index of Activities of Daily Living. Follow-up data were obtained from the NHS Spine.

RESULTS

One, three, and five-year survival was 86.5%, 66.7%, and 44.9%, respectively. In univariate analysis, all three frailty indices were predictive of 5-year survival (Rockwood CFS HR: 1.34 [p < 0.01]; Katz HR: 1.23 [p < 0.01]; Karnofsky HR: 1.21 [p < 0.01]). Three separate multivariable Cox regression models were constructed for each frailty index. In each model, the frailty indices remained predictive of 5-year survival. ROC curve comparison, however, demonstrated the Rockwood CFS model as the best discriminator of 5-year survival (Rockwood CFS model: AUC = 0.59, Karnofsky model: AUC = 0.55, Katz model: AUC = 0.55, p = 0.04); pairwise analysis further confirmed the superiority of the Rockwood CFS model.

CONCLUSION

Our study confirms that frailty is an important predictor of long-term outcome following TAVI. Our study suggests that of the three most commonly used scoring systems, the most useful discriminator of long-term outcome is the Rockwood CFS.