Reclassification of Clinical Frailty Scale for a better prediction of two-year survival after Transcatheter Aortic Valve Implantation

Laura Baez (Jena)1, G. Dannberg (Jena)1, C. Lasch (Jena)1, D. Stoycheva (Jena)1, K. Ibrahim (Chemnitz)2, T. Kräplin (Jena)3, C. Schulze (Jena)1, M. Diab (Rotenburg an der Fulda)4, S. Möbius-Winkler (Jena)1, C. Jung (Düsseldorf)5, M. Franz (Jena)1

1Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 2Klinikum Chemnitz gGmbH Innere Medizin I - Kardiologie Chemnitz, Deutschland; 3Universitätsklinikum Jena Klinik für Herz- und Thoraxchirurgie Jena, Deutschland; 4Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH Rotenburg an der Fulda, Deutschland; 5Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland


Background: The Clinical Frailty Scale (CFS) has been widely used for the prediction of outcomes including mortality in cardiovascular diseases. The commonly used classification into the three categories “fit” (CFS 1-3), “living with very mild frailty” (CFS 4) and “frail” (CFS 5-8) has shown to be difficult to apply to specific patient cohorts and new frailty categories have been recently suggested to better predict outcomes here.

The current study aimed to analyze the value of baseline CFS for the prediction of two-year survival after transcatheter aortic valve implantation (TAVI) and to test, whether the commonly used three categories should be recommended in these particular patients in a real-world setting.

Methods and Results: 

Baseline CFS as well as survival data two years after TAVI were available for 480 patients prospectively included in the Jenaer Aortenklappenregister (JAKR) between 2016 and 2020 at the University Hospital Jena. The single-center study cohort represents a typical elderly patients’ collective suffering from severe symptomatic aortic stenosis eligible for treatment by transfemoral TAVI after heart-team discussion (mean age: 79 ± 7 years; 50% female; mean STS score 4.7 ± 3.9%). Applying the common three categories of CFS as mentioned above, there was a survival rate of 84.9% in “fit” patients, of 79.2% in the “living with very mild frailty” group and of 61% in “frail” subjects. There were no significant differences in the survival rates of the first two groups (p=n.s.). After performing Kaplan Meier analysis including all CFS score values that occurred in our study cohort (1-7, there were no patients with higher values), a reclassification into the following three categories revealed significant differences in the two-year survival rates: “CFS 1-2” with 97.2%, “CFS 3-4” with 81.2% and “CFS 5-7” with 61% (p<0.05 for all groups).

Conclusions: CFS is a valuable and easy-to-use tool for the prediction of two-year survival after TAVI. A reclassification of the commonly used categories as proposed by us might better predict long-term outcome after TAVI in a real-world setting.

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