Abstract 14898: Role of Frailty Measures to Determine the Prognosis of Elderly Patients with Severe Aortic Stenosis

OBJECTIVES: To analyze the survival prediction and usefulness of global frailty measure vs the individual components (gait speed, grip strength, weakness, physical activity and weight loss) to stratify elderly patients with symptomatic severe aortic stenosis (SAS). METHODS: Prospective registry and one-year follow-up of 564 patients older than 74 years diagnosed of symptomatic SAS. Frailty measures included gait speed in a 15 feet distance, grip strength, weakness, weight loss and physical activity using the Physical Activity Surveillance for the elderly (PASE) questionnaire. Patients were classified as frail when they fulfilled three or more of the five criteria. Statistical methods to analyze the relationship between global frailty and individual frailty variables with one-year mortality included chi square for univariate analysis and Cox regression for multivariate analysis. Multivariate analysis was adjusted for received treatment (medical conservative (MC), surgical aortic valve replacement (AVR) or transcatheter aortic valve replacement (TAVR)) RESULTS: Mean age of patients was 82,9 + 4,82, 57.5 % were females and 48 % were in III or IV NYHA functional class or other severe symptomatology. Treatment was MC, AVR and TAVR in 47.3%, 16.7% and 36% respectively, one year-mortality was 18,5% and mean follow-up was 70,1±50,3 weeks. Patients were classified as frail in 44% of cases. Gait speed was (mean 0.6±0.2 m/s) was related with one-year mortality (p=0.02) as were physical activity score (mean 38.3, p=0.07), weakness (present in 43.4%, p=0.001) and weight loss (present in 18%, p=0.01). Grip strength (mean 18,5±7.7 Kg,) was not related with one-year mortality (p=0.07). When general frailty and the four significant frailty variables was introduced in a mortality Cox regression prediction model, only general frailty status retain an independent relation with mortality (OR 2.7, 95% CI 1.39-5.4). CONCLUSION: Although individual variables of frailty are related with mortality and could be used to classify elderly patients with SAS, general frailty considering all five variables should be preferred as it is a more powerful tool to identify high risk patients. Frailty should be included in risk score systems.