Frailty is one of the strongest predictors of long-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR), according to researchers of a major new study. The study, which followed patients for five years, found that those classified as frail faced significantly higher risks of death, stroke, acute coronary syndrome and geriatric complications. Compared to the robust cohort, frail patients had significantly higher 5-year mortality (27.6% vs 8.3%; hazard ratio [HR]: 1.41; 95% confidence interval [CI]: 1.14–1.74), stroke (21.2% vs 1.2%; HR: 18.52; 95% CI: 8.13–42.19), acute coronary syndrome (20.1% vs 1.3%; HR: 8.77; 95% CI: 4.74–16.23) and major bleeding (23.2% vs 1.2%; HR: 19.23; 95% CI: 8.47–43.48). “Geriatric syndromes including delirium, incontinence, depression, and malnutrition were also more prevalent in frail patients,” added the authors of the paper. Clinically relevant Published in JACC: Advances, the study concluded that biological age, represented by frailty, may be more clinically relevant than chronological age in TAVR patients. This was markedly obvious in age-stratified analyses, where even individuals under 75 who were frail experienced significantly worse outcomes than their robust peers. “…aging is a continuum, and frailty can signal physiologic decline in younger patients that may otherwise be missed with traditional age-based criteria,” the paper’s authors wrote. Osamah Badwan, MD, from the Heart, Vascular and Thoracic Institute, Cleveland Clinic, was the first author of the manuscript.. “This aligns with prior literature suggesting that frailty is a more nuanced and predictive measure of health in older adults undergoing TAVR.” Geriatric syndromes Further findings of the study emphasized the considerable burden of geriatric syndromes among frail patients in which depression, delirium, incontinence and malnutrition were more common even though they were not typically included in conventional cardiac risk scores. The research team also argued that including frailty into TAVR evaluation using tools such as 5-factor modified frailty index (MFI-5) could improve patient selection and shared decision-making. “Given its ease of use, reproducibility, and prognostic utility, the MFI provides a pragmatic tool which could aid in preprocedural assessment, optimize patient selection, and support shared decision-making,” the authors concluded. “Assessing biological aging throughout the lifespan is particularly important for younger patients undergoing TAVR.” Source Badwan O, Motairek I, Zghyer F, et al. Frailty Predicts Geriatric and Cardiovascular Adverse Outcomes After TAVR: A 5-Year Real-World Analysis. JACC Adv. 2025 November 24 (Article in Press). Image Credit: Paul Maguire – stock.adobe.com