The Clinical Frailty Scale
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With the emergence of transcatheter aortic valve replacement (TAVR) as a therapeutic option to treat high-risk older adults with aortic stenosis, the geriatric concept of frailty has assumed mainstream relevance for cardiovascular practitioners. We have eagerly adopted tools to objectify the definition of frailty and accordingly discern good and bad candidates among a pool of complex octogenarians with multiple chronic conditions, a daunting yet mission-critical task. Initial studies published during the first half of this decade revealed that frailty status was one of the top predictors of midterm mortality and incident disability after TAVR,1 leading to its integration in clinical care pathways and predictive risk models. The encouraging findings from small single-center studies are now being validated in larger multicenter registries and trials, affirming the strengths and uncovering the limitations of various frailty assessment tools.
In this issue of Circulation, Shimura et al2 have presented an analysis of the prospective OCEAN-TAVI registry (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation) encompassing 1215 high-risk patients who underwent TAVR at 9 centers in Japan between 2013 and 2016. For the purposes of this analysis, the primary predictor variable was Rockwood’s Clinical Frailty Scale (CFS) ascertained by trained medical professionals who had direct contact with the patients and their families before TAVR. The CFS is a semiquantitative tool that provides a global score ranging from 1 (very fit) to 9 (terminally ill) to reflect the following domains: disability for basic and instrumental activities of daily living, mobility, activity, energy, and disease-related symptoms. Higher CFS scores were associated with slightly older age, a greater proportion of women, …