Essential Frailty Toolset outperforms others in predicting mortality after TAVR, SAVR
Compared with six other scales that measure frailty, one called the Essential Frailty Toolset stands out for its ability to predict mortality 30 days after two types of valve replacement surgery. It can also predict worsening disability at one year, according to a new study.
Jonathan Afilalo, with the division of cardiology at Jewish General Hospital, McGill University in Montreal, led the research team. The group wrote that frailty plays a key role in defining an older patient’s potential to recover after either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
The study was published in the August issue of the Journal of the American College of Cardiology.
National guidelines strongly encourage the objective assessment of frailty prior to valve replacement operations. However, these guidelines also acknowledge a lack of clarity regarding the best tool to use for such assessments. The researchers wrote, “Lack of consensus is a major reason why frailty is often not measured in clinical practice.”
Accordingly, they undertook a head-to-head comparison of seven scales: 1. Fried, 2. Fried+, 3. Rockwood, 4. Short Physical Performance Battery, 5. Bern, 6. Columbia and 7. Essential Frailty Test (EFT).
The study cohort included 1,020 adults with a median age of 82 years. As measured by the various scales listed above, the prevalence of frailty ranged from 26 percent to 68 percent.
The EFT had the most predictive value for worsening disability at one year post operatively and for death at 30 days.
“The time and resources required to administer the EFT are minimal and its components can be intervened upon before or after the procedure to optimize outcomes,” stated the researchers.
They also called for further investigations to assess the value of improved nutrition and exercise to diminish frailty and to improve post-operative recovery for patients undergoing cardiovascular interventions.