International Society For Minimally Invasive Cardiothoracic Surgery

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Preliminary Results From The Fifa-trial ( Fitness-tracker Assisted Frailty-assessment Before Transcatheter Aortic Valve Implantation)
Victoria Watzal1, Bernhard Winkler1, Gabriel Weiss1, Andreas Strouhal2, Christoph Adlbrecht2, Georg Delle-Karth2, Martin Grabenwöger3, Markus Mach4.
1Department of Cardio-Vascular Surgery, Hospital Hietzing and Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria, 24th Medical Department and Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Hietzing Hospital, Vienna, Austria, Vienna, Austria, 3Department of Cardio-Vascular Surgery, Hospital Hietzing; Karl Landsteiner Institute for Cardio-Vascular Research; Sigmund Freud University, Medical Faculty, Vienna, Austria, Vienna, Austria, 4Department of Cardio-Vascular Surgery, Hospital Hietzing and Karl Landsteiner Institute for Cardio-Vascular Research, Department of Cardio-Vascular Surgery, University Hospital Graz, Austria, Vienna, Austria.

Background Frailty is a geriatric syndrome frequently observed in elderly high-risk patients undergoing transcatheter aortic valve implantation (TAVI) which decreases the potential for functional recovery after TAVI and diminishes postoperative life expectancy.
The study sought to develop a preprocedural frailty assessment based on parameters measured by a wearable health monitoring device. The predictive performance of this multimodality frailty assessment (MFA) with respect to hospital mortality after TAVI was compared to conventional frailty scoring methods.
Methods A prospective cohort of elderly adults undergoing TAVI procedure via a transapical approach between December 2017 and December 2018 in a single centre was included in the present study. Patients wore the device for one week prior the procedure. Threshold levels in three categories (steps, heart rate range, stress) were calculated with ROC analysis. The patients were assigned one point per category when exceeding the cut-off value and then classified in four stages (no, borderline, frail, very frail). The MFA was then compared to gait speed category derived from 6-minute-walking-test (GSC) and the Edmonton Frailty Scale classification (EFS-C). The primary study endpoint was hospital mortality.
Results In total, 36 patients with a mean age of 77.75 years (±5.1) were included. All-cause hospital mortality was 8.3% (n=3). Depending on the frailty scores used, the prevalence of frailty ranged from 55.5% (MFA) and 60.6% (EFS-C) to 62.5% (GSC). Overall preprocedural stress level (p=0.036), minutes of high stress per day (p=0.042), minutes of rest per day (p=0.034) and daily heart rate maximum (p=0.036) as single parameters were the strongest predictors of hospital mortality. When comparing the different frailty scores, the MFA demonstrated the highest predictability of hospital mortality (MFA: AUC: 0.845 (0.657-1.000), p=0.052; GSC: AUC: 0.730 (0.474-0.986), p=0.196; EFS-C: AUC: 0.638 (0.265-1.000), p=0.438).
Conclusions The preliminary findings of this study demonstrate the strong predictive performance of MFA compared to conventional frailty methods. The promising initial results warrant further evaluation of MFA as a predictor of short and long-term mortality after transcatheter structural interventions or conventional surgery.
Comparison of the different frailty scores with ROC analysis

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