# Prognostic Impact of Frailty in Transcatheter Aortic Valve Implantation

## TL;DR

This study shows that measuring frailty and cognitive function improves predicting outcomes after heart valve surgery compared to traditional risk models.

## Contribution

The study demonstrates that functional and cognitive frailty assessments outperform conventional surgical risk scores in predicting mortality after TAVI.

## Key findings

- EFT and Katz Index had higher accuracy in predicting 1-year mortality than EuroSCORE II and STS-PROM.
- Cognitive impairment independently predicted 1-year mortality after adjustment.
- HALP was not associated with clinical outcomes in TAVI patients.

## Abstract

Background: Frailty strongly influences outcomes after transcatheter aortic valve implantation (TAVI), but conventional risk models insufficiently capture functional and cognitive vulnerability. We compared conventional surgical risk scores with multidimensional frailty assessment and a biological score. Methods: This observational registry included 528 consecutive patients with severe symptomatic aortic stenosis undergoing TAVI between January 2019 and November 2024. Frailty was assessed using the Essential Frailty Toolset (EFT), Katz Index, and cognitive screening, alongside French Aortic National CoreValve and Edwards 2 (FRANCE-2) and Age, Creatinine, and Ejection Fraction (ACEF) scores. HALP was calculated as (haemoglobin × albumin × lymphocytes) ÷ platelets. Primary endpoints were 30-day, 6-month, and 1-year all-cause mortality. Secondary outcomes included non-fatal major adverse cardiovascular events (MACE), complications, and quality-of-life improvement. Results: One-year mortality was 12.7%. EFT and Katz Index showed the strongest discrimination for 1-year mortality (AUC 0.72 and 0.75), outperforming EuroSCORE II and STS-PROM (AUC 0.66 and 0.68). After adjustment, EFT (HR 1.91, 95% CI 1.47–2.48), Katz Index (HR 0.57, 95% CI 0.47–0.70, and cognitive impairment (HR 2.24, 95% CI 1.34–3.75) independently predicted 1-year mortality. HALP was not associated with outcomes. FRANCE-2 independently predicted 1-year MACE (HR 1.24, p = 0.019). Conclusions: Functional frailty and cognitive impairment add prognostic value beyond conventional comparator models, whereas HALP does not. Brief functional and cognitive screening may help Heart Teams identify patients who need closer peri-procedural optimisation, rehabilitation planning, and discharge support rather than relying on surgical risk scores alone.