Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement
Authors: Shimura Tetsuro , Yamamoto Masanori , Kano Seiji , Kagase Ai , Kodama Atsuko , Koyama Yutaka , Tsuchikane Etsuo , Suzuki Takahiko , Otsuka Toshiaki , Kohsaka Shun , Tada Norio , Yamanaka Futoshi , Naganuma Toru , Araki Motoharu , Shirai Shinichi , Watanabe Yusuke , Hayashida Kentaro , Yashima Fumiaki , Inohara Taku , Kakefuda Yuki , Arai Takahide , Yanagisawa Ryo , Tanaka Makoto , Kawakami Takashi , Maekawa Yuichiro , Takashi Kohno , Yoshitake Akihiro , Iida Yasunori , Yamazaki Masataka , Shimizu Hideyuki , Yamada Yoshitake , Jinzaki Masahiro , Tsuruta Hikaru , Itabashi Yuji , Murata Mitsushige , Kawakami Michiyuki , Fukui Shogo , Sano Motoaki , Fukuda Keiichi , Hosoba Soh , Sato Hirotomo , Teramoto Tomohiko , Kimura Masashi , Sago Mitsuru , Tsunaki Tatsuya , Watarai Shoko , Tsuzuki Masanao , Irokawa Keisuke , Shimizu Kazuki , Kobayashi Toshihiro , Okawa Yasuhide , Miyasaka Masaki , Enta Yusuke , Shishido Koki , Ochiai Tomoki , Yamabe Tsuyoshi , Noguchi Kenichiro , Saito Shigeru , Kawamoto Hiroyoshi , Onishi Hirokazu , Yabushita Hiroto , Mitomo Satoru , Nakamura Sunao , Yamawaki Masahiro , Akatsu Yui , Honda Yosuke , Takama Takuro , Isotani Akihito , Hayashi Masaomi , Kamioka Norihiko , Miura Mizuki , Morinaga Takashi , Kawaguchi Tomohiro , Yano Mariko , Hanyu Michiya , Arai Yoshio , Tsubota Hideki , Kudo Masafumi , Kuroda Yuki , Kataoka Akihisa , Hioki Hitofumi , Nara Yugo , Kawashima Hideyuki , Nagura Fukuko , Nakashima Makoto , Sasaki Kazuya , Nishikawa Junichi , Shimokawa Tomoki , Harada Tadanori , Kozuma Ken 
Published: March 2017

Background:
The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.

Methods:
We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.

Results:

Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077,
P
=0.007), albumin (ρ=−0.22,
P
<0.001), gait speed (ρ=−0.28,
P
<0.001), and grip strength (ρ=−0.26,
P
<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%,
P
<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49;
P
<0.001).

Conclusions:
In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.