Canadian Journal of Cardiology


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      Frailty is a major risk factor for adverse outcomes in patients undergoing heart valve surgeries, however, ideal measures to identify frailty in a clinical setting remains. The Essential Frailty Toolset (EFT) was developed in patients undergoing aortic valve replacement procedures and was shown to outperform other frailty tools in terms of prognostic value and feasibility. Thus, the objective of this study was to expand the utility of the EFT in another cardiovascular cohort and determine its prognostic value for all-cause mortality in patients undergoing mitral valve surgery.


      The McGill Frailty Registry prospectively included patients ≥60 years of age undergoing surgical or percutaneous mitral valve replacement/repair 2011-2020 at two university hospitals (Jewish General Hospital and Royal Victoria Hospital; Montréal, QC). The EFT score was analyzed as a continuous and trichotomous variable. EFT was measured preoperatively and was scored 0 to 5 based on the following 4 components: anemia, hypoalbuminemia, lower extremity weakness defined as time of ≥ 15 seconds or inability to complete 5 chair rises without using arms and cognitive impairment defined as < 24 on Mini-Mental Status Examination. The primary endpoint was 1-year all-cause mortality assessed by logistic regression. The cohort consisted of 202 patients with a mean age of 75.5 ± 7.6 years and a mean EFT of 1.7 ± 1.2 points. In total, 32 (16%) were non-frail with an EFT of 0 points, 114 (56%) were pre-frail with an EFT of 1-2 points, and 56 (28%) were frail with an EFT of 3-5 points. At the 1-year follow-up, 44 deaths were observed. After adjustment, each incremental EFT point was associated with a odds ratio of 1.49 (CI 1.07, 2.08). Compared to those not frail, frail patients had a 5-fold increase in all-cause mortality at 1-year (odds ratio: 5.32, CI 1.07, 26.35)


      The EFT is pragmatic and a highly prognostic tool to measure frailty and guide decision-making for mitral valve surgery in older adults. Furthermore, the subdomains of the EFT may be actionable through targeted interventions such as cardiac rehabilitation and nutritional optimization.
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