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Li Z, Dawson E, Moodie J, Martin J, Bagur R, Cheng D, Kiaii B, Hashi A, Bi R, Yeschin M, John-Baptiste A. Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. BMJ Open 2021; 11:e040459. [PMID: 33664067 PMCID: PMC7934784 DOI: 10.1136/bmjopen-2020-040459] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Our objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI. METHODS We systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates. RESULTS Of 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates. CONCLUSIONS Frailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency. PROSPERO REGISTRATION NUMBER CRD42018090597.
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Affiliation(s)
- Zhe Li
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Emily Dawson
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Jessica Moodie
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Janet Martin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Davy Cheng
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Medicine, Division of Critical Care Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bob Kiaii
- Department of Surgery, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Adam Hashi
- Faculty of Sciences, Western University, London, Ontario, Canada
| | - Ran Bi
- Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Michelle Yeschin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ava John-Baptiste
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
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