Frailty status more predictive of TAVR outcomes than cancer status
Click Here to Manage Email Alerts
Among patients undergoing transcatheter aortic valve replacement, increased frailty was independently associated with worse outcomes, including all-cause death, whereas cancer history did not independently affect frailty-adjusted mortality.
In a single-center analysis of adults with aortic stenosis stratified by cancer history, researchers also found that composite frailty score was not associated with outcomes after TAVR in the active/recent cancer and remote cancer cohorts.
“This retrospective study demonstrated that when evaluating patients with active or a prior history of cancer for TAVR, factoring in measures of frailty may be more predictive of how they fare with life span and quality of life than having cancer itself,” Eric H. Yang, MD, FACC, FASE, FAHA, an associate clinical professor of medicine at the Ronald Reagan UCLA Medical Center, told Healio.
In a retrospective study, Yang and colleagues analyzed data from 640 adults with aortic stenosis who underwent TAVR at UCLA between August 2012 and May 2020 and had an active or recent history of cancer (n = 107), a remote history of cancer (achieved remission more than 5 years ago; n = 85) or no cancer history (n = 448). Researchers assessed frailty via serum albumin, hemoglobin, gait speed, functional dependence and cognitive impairment measures. The primary outcome was a composite of all‐cause mortality and quality of life at 1 year. A poor primary outcome was defined as either death, Kansas City Cardiomyopathy Questionnaire-Overall Summary Score (KCCQ‐OS) of 45 or lower or a KCCQ-OS decline of at least 10 points from baseline.
The findings were published in Clinical Cardiology.
The all‐cause mortality rate was 11.4% in the active/recent cancer cohort, 10% in the remote cancer cohort, and 9.5% in the noncancer cohort (P = .829). The percent of patients with a KCCQ‐OS of 45 or less or with a 10-point or greater decrease from baseline was 12.5% in the active/recent cancer group, 8.5% in the remote cancer group and 9.6% in the noncancer group (P = .739).
Researchers found that frailty was associated with the primary outcome only in the noncancer cohort (P = .004) in univariate analyses. In multivariate analyses, cancer history was not associated with a poor primary outcome (OR for active/recent cancer = 1.3; 95% CI, 0.8-2.3; P = .326; OR for remote cancer = 1; 95% CI, 0.5-1.9; P = .646), whereas frailty was (OR = 1.7; 95% CI, 1.1-2.8; P = .028).
In the noncancer cohort, a high composite frailty score correlated with a poor composite outcome (OR = 2.3; 95% CI, 1.3-3.9; P = .004), mortality (OR = 2; 95% CI, 1-3.8; P = .045), poor quality of life (OR = 2.8; 95% CI, 1.2-6.7; P = .018) and higher readmission rates (OR = 2.5; 95% CI, 1.6-3.9; P < .001).
The researchers noted the findings show frailty status should be “heavily considered” during a TAVR evaluation.
“The diagnosis of cancer may lead TAVR programs to shy away from treating these patients because of concerns of overall prognosis,” Olcay Aksoy, MD, associate clinical professor of medicine, associate director of the TAVR program and associate director of clinical research in interventional cardiology at UCLA, told Healio. “However, given rapid advances in cancer treatments and the wide heterogeneous spectrum of how cancer [progresses], many patients can live longer on effective treatments, even if not cured of their cancer. For these patients that present with aortic stenosis, TAVR technology may be an invaluable treatment in the right patient with active or prior cancer, but programs should integrate objective measures of frailty to see which patients overall will benefit from this treatment. Given the complexity of these patients, heart team discussions should include oncology and cardio-oncology teams.”
For more information:
Olcay Aksoy, MD, can be reached at oaksoy@mednet.ucla.edu; Twitter: @olcayaksoymd.
Eric H. Yang, MD, FACC, FASE, FAHA, can be reached at ehyang@mednet.ucla.edu; Twitter: @datsunian.
Collapse
Click Here to Manage Email Alerts