Preoperative frailty and risk of unplanned readmission and mortality within the first year after transcatheter aortic valve implantation
M Lachonius, N Straiton, A Israelsson Skogsberg, P Petursson, S J NielsenAbstract
Background
Frailty is associated with increased mortality following transcatheter aortic valve implantation (TAVI). It is not clear how the level of preoperative frailty is associated with the risk of unplanned readmission. Therefore, we examined the risk of mortality and unplanned readmission the first year after TAVI, in relation to preoperative frailty level.
Methods
All patients, aged >65 years, who were treated with TAVI at a Swedish University Hospital from November 2019 to December 2023 were included in the study. To estimate preoperative frailty, we used Clinical Frailty Scale (CFS), divided in three frailty groups. To compare the proportions of mortality and unplanned readmission, Chi2 and Fischer’s exact test were used. Cumulative survival analysis was performed. The risk of mortality and unplanned readmission was estimated by using relative risk estimate calculation.
Results
In total, 460 TAVI patients were included (mean age 81.8 years, SD 5.4), 50.7% women. Preoperatively, 19% of the patients were assessed as not frail (CFS 2–3), 58% with very mild frailty (CFS 4) and 23% with mild to moderate frailty (CFS 5–6). Within the first year after TAVI, there was a significant difference in cumulative survival between patients in CFS groups 2–4 and 5–6, favouring CFS groups 2–4 (p=0.001). The mortality rates within the first year after TAVI were 5.9% in CFS group 2–3, 3.0% in CFS group 4, and 12.3% in CFS groups 5–6 (p = 0.02). Overall, 28.9% of the patients had unplanned readmission by any reason the first year after TAVI. The proportion of patients with an unplanned readmission within the first year was 22.1% in CFS groups 2–3, 26.5% in CFS group 4, and 37.7% in CFS groups 5–6 (p=0.04). Patients in CFS group 5–6 had a significantly higher cumulative rate of unplanned readmission compared with patients in CFS groups 2–4 (p=0.01). The relative risk (RR) of unplanned readmission was 1.48 (95% CI: 1.10–2.01) in patients with mild to moderate frailty (CFS 5–6) compared with those with no to very mild frailty (CFS 2–4) (p = 0.02). Overall, readmission occurred in 13.0% for cardiovascular, 1.2% for neurological, and 16.0% for other reasons. In total, 9.9% of the patients had >1 unplanned hospitalizations, 7.1% in CFS 2–3, 8.6% in CFS 4 and 14.4%in CFS 5–6 (p=0.12).
Conclusions
Patients with mild to moderate frailty had a significantly higher risk of both mortality and unplanned readmission the first year following TAVI than patients with no or very mild frailty. These results emphasize the importance of evaluate level of frailty preoperatively, in order to facilitate a careful patient selection to TAVI. Furthermore, patients who are mildly or moderate frail before TAVI need to receive effective approaches to mitigate the negative consequences of frailty.KM-curves mortalityKM- curves unplanned readmission