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Frailty assessment using the FORECAST is a valid tool to predict mortality after transcatheter aortic valve implantation - Results from the “Comprehensive assessment of Frailty” validation study
Simon H. Sündermann1, Alexander Meyer1, Adrian Kobe2, Hassan Elmubarak3, Thomas Walther3, Jörg Kempfert1, Volkmar Falk1.
1Deutsches Herzzentrum Berlin, Berlin, Germany, 2University Hospital Zurich, Zurich, Switzerland, 3Kerkhoff Clinic, Bad Nauheim, Germany.
OBJECTIVE: The term frailty is used frequently during decision making in transcatheter heart valve procedures. Nevertheless, fraity is still measured by eyeballing rather than by using frailty assessments. In a previous study we developed a frailty assessment in a cardiac surgical patient population including patients which underwent transcatheter heart valve replacement (TAVR). Here we present the results from the validation study focusing on the TAVI cohort.
METHODS: One-hundred-thirty patients underwent a TAVI procedure in a center in Switzerland and in Germany. Frailty assessment using the FORECAST (Frailty predicts death One year after Elective Cardiac Surgery Test) was performed for every patient before the procedure. EuroSCORE and STS-Score were assessed as well. Follow-up included assessment of in-hospital mortality, mortality after 30 days, quality of life at follow-up using the SF-36 assessment.
RESULTS: Mean age of the patients was 83.3 years. 50% were female. LogEuroSCORE was 15 ± 8.7%, STS-Score was 5.1 ± 3.4%. More then 80% of the patients lived at home before the procedure, either alone or with their spouse. Mean FORECAST Score was 4.8 ± 3.3 points out of 15. In hospital and 30-days mortality was 1%. Stroke rate was .3% in-hospital and .2% at 30days follow up. In regards to the SF-36, quality of life decreased significantly in 4 out of 10 items (Role emotion, general health, social functioning and the mental health component summary score) after the intervention. Kruskas-Wallis test showed that the FORECAST is a valid tool to predict in-hospital mortality and thirty days mortality after TAVI. By combining the FORECAST and the STS-Score, this effect was even higher. The area-under the receiver operating characteristics curve was 0.7 for in-hospital mortality and 0.76 for 30-days mortality summing up both scores. Stratifying the patients according to their FORECAST score showed highest probability of mortality in the highest frailty group (Figure 1).
CONCLUSIONS: The FORECAST is a valid tool to assess frailty in TAVI patients which is relevant to predict short term outcome. 
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