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BACKGROUND
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.
METHODS AND RESULTS
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)
CONCLUSION
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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© 2021 Published by Elsevier Inc.
