P3743A routine nursing questionnaire adds predictive value to conventional risk scores for TAVI (Transcatheter Aortic Valve Implantation) outcome

Background

Previous studies indicate that frailty is associated with poor outcome following TAVI.

Purpose

This study aimed to investigate whether a questionnaire routinely administered by nurses might serve as a surrogate for frailty and predict outcome in TAVI patients in addition to conventional risk scores.

Methods

This is a retrospective single-centre study performed at a university clinic with a high volume of TAVI. We included 461 consecutive patients (age 82±6 years, 60.5% female) scheduled for TAVI between 2012 and 2016. Based on seven questions addressing levels of patients' self-dependence assessed by nurses on admission, TAVI patients were divided into a “frail” group (at least one answer indicating limited self-dependence) and a self-dependent group (all other patients). We sought to assess (1) prevalence of frail TAVI patients, and (2) impact of frailty on two-year mortality assessed by Cox regression in addition to established risk scores.

Results

The prevalence of frail TAVI patients was 40.3%. Frail patients had significantly higher two-year mortality than self-dependent (non-frail) patients (25.3% vs 14.9%, p=0.014, Figure). In multivariate analysis stratified for age and left-ventricular function, body mass index (BMI), atrial fibrillation (AF) and frailty were significant predictors of increased two-year mortality (BMI, per kg/m2: HR 0.95 [95% CI 0.90–0.99], p=0.028; AF: HR 2.07 [1.35–3.18], p=0.001; frailty: HR 1.81 [1.18–2.76], p=0.006).

In addition to the Society of Thoracic Surgeons (STS) risk of mortality score, both AF and frailty significantly predicted increased two-year mortality (AF: HR 2.02 [1.32–3.09], p=0.001; frailty: HR 1.55 [1.01–2.38], p=0.045).

Conclusion

This study shows that a routine nurses' questionnaire covering levels of self-dependence serves as risk indicator for long-term mortality after TAVI. This unconventional geriatric assessment adds predictive power for two-year-mortality to a conventional risk score (such as STS) and might be used to stratify patients for greatest benefit from TAVI.