Frailty impacts outcomes in critical Acute Myocardial Infarction (AMI). This study evaluates three Hospital Frailty Risk Measure (HFRM) formats-continuous score, 8 risk groups, and binary classification-for predicting clinical outcomes.

Using 2129 critical AMI patients' data from MIMIC-IV, logistic and COX regression models assessed associations between HFRM formats and outcomes (ICU mortality, in-hospital mortality, discharge with nursing support, one-year mortality), adjusted for age, gender, smoking, and NSTEMI.

All HFRM formats consistently predicted adverse outcomes. The continuous score showed increased adjusted odds/hazard ratios for ICU mortality (OR 1.289, 95 % CI:1.065-1.516), in-hospital mortality (OR 1.343, 95 % CI:1.161-1.554), nursing support discharge (2.389, 95 % CI: 1.960-2.912), and one-year mortality (1.709, 95 % CI:1.533-1.904). The binary measure (groups 4-8 as frail) demonstrated higher adjusted risks for all outcomes except ICU mortality.

HFRM effectively predicts adverse outcomes in critical AMI. The binary classification offers robust risk stratification, underscoring frailty assessment's role in personalized care planning.

Degenerative aortic stenosis (AS) is an aging-associated disease with alarmingly high mortality that has risen in prevalence in tandem with the global population aging. Treatment options for AS are currently limited to surgical or percutaneous valve intervention, which are associated with significant morbidity. It is increasingly recognized that the care of AS patients is frequently constrained by concomitant frailty, an under-recognized syndrome among older individuals. Many AS patients have concurrent aging-associated diseases, including atherosclerotic diseases, organ impairment, physical frailty, and nutritional deficiencies which limit functional improvement after valve intervention. It has become increasingly crucial for clinicians to address these concurrent issues in frail, older individuals with AS to achieve the best possible outcomes. We aim to review the well-studied relationship between frailty and AS, as well as possible strategies for periprocedural optimization and risk management.

Amyloidosis, which is caused by misfolded proteins that form amyloid fibrils, is predominantly diagnosed in older adults. Although previously considered a rare disease, increased awareness and noninvasive diagnostic methods have resulted in a rise in diagnoses. As a multisystem disease that affects multiple organ systems (cardiac, gastrointestinal, renal, and neurological), there is significant overlap with both geriatric conditions and common conditions in heart failure. Frailty is recognized as a distinct biological syndrome of declines across multiple physiological systems, which prevents maintenance of homeostasis and limits the ability to respond to stressors. Frailty was initially characterized as physical frailty alone; however, it is increasingly recognized that it is multidimensional with components including nutrition, cognitive, psychological, and social. Frailty in cardiovascular disease has become an important risk factor, indicator for disease severity, and can help guide decisions around intervention. In certain patients, frailty may be reversible. Given the lack of consensus definitions, tools, and implementation of frailty in both clinical and research settings in the field of amyloidosis, we convened a group of experts from cardiology, geriatric cardiology, geriatrics, hematology, and allied health to form this state-of-the-art review. There are many points of intersectionality between amyloidosis, aging, and frailty which herald a need for multidisciplinary care. This review document aims to provide guidance in how to understand and address frailty in older patients with a specific focus on cardiac amyloidosis.

Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.

A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).

Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (Pinteractionfrailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (Pinteractionfrailty × intervention arm < 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.

Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.

The clinical indicators of patients with coronary artery disease (CAD) often affect their prognosis. Cardiopulmonary Exercise Testing (CPET) can effectively evaluate the cardiopulmonary ability of CAD patients. The objective of this research was to explore the correlation between some clinical indicators and peak metabolic equivalents (peak METs) and peak oxygen pulse (O2Ppeak) in patients with CAD. Regression equations were further constructed for indicators with significant correlations to predict peak METs and O2Ppeak.

152 CAD patients were recruited (M: F = 109:43, age = 64.47 ± 7.80 years, including 32 patients with chronic myocardial infarction, 46 with frailty, 93 with hypertension, and 48 with diabetes). All participants had blood biochemistry analysis, cardiac ultrasound, CPET and five time sit-to-stand (FTSTS) test. CPET was tested according to an incremental loading scheme of 10-15 w/min and peak METs, O2Ppeak were recorded. Stepwise multifactorial linear regression was used to determine which clinical variables should be adjusted to improve peak METs and O2Ppeak.

Results of multifactorial linear regression showed 2 equations: peak METs = 6.768-0.116*BMI + 0.018*Hgb-0.026*age-0.005*Gensini score (Adjusted R2 = 0.301, F = 17.239, p < 0.001); O2Ppeak = -1.066 + 0.264*BMI + 0.049*Hgb-0.035*age (Adjusted R2 = 0.382, F = 32.106, p < 0.001).

BMI, Hgb, age and Gensini score can be used to predict peak METs and BMI, Hgb and age can be used to predict O2Ppeak in patients with CAD clinically. Thus, tailored exercise program should be prescribed for individual CAD patient undergoing cardiac rehabilitation and modifying clinical factors such as BMI, Hgb and Gensini score will help to improve their cardiorespiratory fitness and quality of life.

Good functional recovery after cardiac surgery can be reported as 'days alive and out of hospital' in the first 30 days after a procedure (DAOH30) and 'days at home' in the first year (DAH365), which integrate several clinically important outcomes, including death, hospital length of stay, quality of recovery and hospital readmission. They depend on the preservation or early recovery of physiological and functional capacity, both of which may be lost in patients living with frailty.

We measured frailty with a multidimensional approach, incorporating 30 variables spanning comorbidity, sensory, cognitive, psychosocial, disability and pharmaceutical domains, which together make up the Patient Frailty Index (pFI). We further explored the impact of socioeconomic factors on functional recovery using the Welsh Index of Multiple Deprivation (WIMD). The outcome measures included duration of level 3 and level 2 care, duration of hospital stay, readmission and both short- and longer-term mortality. A total of 669 patients were included in the final analysis. A total of 224 (33.5%) of the patients were 'frail'. They were more likely to have chronic obstructive pulmonary disease, heart failure and diabetes and to be in the lowest decile for deprivation. Frailty was not associated with either sex or advanced age. Patients deemed to be 'frail' had a longer stay in intensive care, required level 3 cardiovascular and respiratory support for longer and stayed longer in the hospital. They spent fewer days at home in the first 30 days, largely due to days requiring advanced cardiovascular support, and fewer days at home in the first year, with most days lost to patients who died in the first year following their surgery. A moderation analysis examined whether the WIMD modified the effect of frailty on recovery after cardiac surgery. The interaction term, after confirming there were no collinearity concerns, was not significant, either for DAOH30 or DAH365, indicating no evidence of moderation.

Short- and medium-term measures of good functional recovery were lower in 'frail' patients, and longer-term survival was also significantly reduced. An accumulation of deficits assessment of frailty, incorporating multiple domains, builds a more accurate picture of increasing vulnerability and can be acquired from patients' electronic health records. In a surgical population that is increasingly comorbid, these findings should inform decisions on preoperative priority setting, prehabilitation, postoperative resources and discharge planning.

Comprehensive geriatric assessment (CGA) prior to transcatheter aortic valve replacement implantation (TAVI) for severe aortic stenosis (AS) may improve the selection of patients targeted for this strategy. Despite the fact that CGA includes multiple scales, comparative data among them are limited. Our aim was to evaluate the discriminative capacity of different scales used in CGA on the decision of suitability for TAVI implantation and the influence on prognosis after TAVI implantation.

Single-center prospective observational study including consecutive patients with severe AS referred for TAVI implantation. A CGA was performed in all patients including scales of functionality, frailty, cognitive impairment and comorbidities. The predictive capacity of each of the scales was evaluated. The development of major adverse cardiovascular events (MACE: cardiovascular mortality, heart failure [HF] and stroke) was analyzed during follow-up.

A total of 142 patients were selected as candidates for TAVI (80.2%), and 121 were finally implanted. The mean age was 83±4.9 years. Patients who were candidates for TAVI had less valvular area, less atrial fibrillation (AF), less cognitive impairment, more autonomy and less frailty. The SPPB frailty and Barthel functional assessment scales were the main scales of the CGA for the TAVI candidacy decision. After TAVI implantation, 21.5% presented a MACE event, with an overall mortality of 19.8% (6.6% cardiovascular). Patients with a higher rate of events and mortality had more AF, HF, renal disease and malnutrition, as well as less family coverage.

In elderly patients with severe AS, the CGA is a determining factor in the selection of candidates for TAVI, with frailty and functional assessment being the most important aspects. Family support and nutritional status have a high impact on the prognosis of patients after TAVI.

The benefit of early cardiac rehabilitation after transcatheter aortic valve replacement (TAVR) is not well established. This pilot study evaluated the feasibility and short-term effects of a home-based exercise program, with or without cognitive-behavioral intervention (CBI).

We randomized 51 patients (mean age, 83.9 years; 19 women) to a home-based exercise program with CBI (Group A; n = 18) or without CBI (Group B; n = 15), or telephone-based education control (Group C; n = 18). The exercise program focusing on balance, flexibility, strength, and endurance began within 7 days post-discharge and was delivered once weekly by a physical therapist for 8 weeks. CBI included discussions on exercise benefits and barriers, goal setting, detailed exercise planning, and a weekly cash adherence incentive. The primary outcome was a disability score (range: 0-22; higher scores indicate greater disability) at 8 weeks. Secondary outcomes included the Short Physical Performance Battery (SPPB) (range: 0-12; higher scores indicate better function), self-efficacy, and outcome expectation scores. Feasibility outcomes included adherence and drop-out rates.

Fifteen participants (83.3%) in Group A, 10 (58.8%) in Group B, and 10 (52.6%) in Group C completed ≥ 5 of the eight assigned weekly sessions (p = 0.196). Two participants in each group were lost to follow-up. At 8 weeks, the home-based exercise groups (Group A and B combined) demonstrated lower disability scores (mean [SE]: 2.6 [0.3] vs. 4.5 [0.5]; p = 0.042) and higher SPPB scores (9.5 [0.6] vs. 6.5 [0.8]; p = 0.003) compared with the education group (Group C). Group A had lower disability scores than Group B (2.1 [0.4] vs. 3.4 [0.5]; p = 0.047), with no differences in self-efficacy and outcome expectation scores.

An early, home-based, multi-domain exercise program appears feasible and may prevent disability and improve physical function in older adults after TAVR. Adding CBI, including a modest cash incentive, showed trends toward improved adherence and reduced disability.

NCT02805309.

Frailty portends worse outcomes for patients with advanced heart failure (HF) undergoing surgical advanced therapies. Falls are characteristic of frailty, but it is unknown if the history of falls predicts post-operative risk. We hypothesized that a one-item fall screening is associated with worse outcomes.

We conducted a retrospective study of all patients undergoing orthotopic heart transplantation (OHT) or left ventricular assist device (LVAD) implantation at our institution between 2020 and 2023. Our primary exposure of interest was falls, as assessed by a nursing questionnaire within 12 months or less prior to surgery. We tracked hospital- and ICU-length of stay, duration of mechanical ventilator use, renal replacement therapy (RRT), and survival.

History of falls was associated with prolonged mechanical support (mean difference: +1.5 days, p = 0.002), prolonged ICU stay (mean difference: +13 days, p = 0.03), and prolonged hospital stay (mean difference: +17 days, p = 0.03). Patients with a history of falls also had a higher rate of needing RRT in the 90 days following surgery (adjusted HR: 4.7, 95% CI 1.1-20, p = 0.035). There were no differences in survival between the two groups.

Among patients with advanced HF undergoing OHT or LVAD, a simple one-item nursing falls assessment is associated with clinically relevant worse outcomes.

Advancements in surgical care have made it possible to offer cardiac surgery to an older and frailer patient cohort. Frailty has been recognised as a prognostic indicator that impacts post-operative recovery and patient outcomes. The aim of this study is to identify frailty assessment tools, evaluate the impact of frailty on post-operative outcomes, and explore strategies to optimise care for frail patients undergoing cardiac surgery.

A comprehensive literature search was performed across PubMed, MEDLINE, and SCOPUS to identify articles reporting post-operative outcomes related to frail patients undergoing cardiac surgery.

Measurement tools such as gait speed, the Clinical Frailty Scale, Fried frailty phenotype, deficit accumulation frailty index and the Short Physical Performance Battery can be used to assess frailty. Frailty has been reported to increase the risk of post-operative morbidity and mortality. Multiple studies have also reported the association between frailty and an increased length of intensive care unit and hospital stays, as well as an increased risk of post-operative delirium. It is important to perform a comprehensive frailty assessment and implement perioperative optimisation strategies to improve outcomes in this patient population. Pre-operative strategies that can be considered include adequate nutritional support, cardiac prehabilitation, and assessing patients using a multidisciplinary team approach with geriatric involvement. Post-operatively, interventions such as early recognition and treatment of post-operative delirium, nutrition optimisation, early planning for cardiac rehabilitation, and occupational therapy can support patients' recovery and reintegration into daily activities.

The early identification of frail patients during the perioperative period is essential for risk stratification and tailored management strategies to minimise the impact of frailty on outcomes following cardiac surgery.

To create a mixed valvular heart disease (MVHD)-related age-adjusted comorbidity index (MVACI) model for predicting mortality risk of patients with MVHD.

A total of 4080 patients with moderate or severe MVHD in the China-VHD study were included. The primary endpoint was 2-year all-cause mortality. A MVACI model prediction model was constructed based on the mortality risk factors identified by univariate and multivariate Cox regression analysis. Restricted cubic splines were used to assess the relationship between MVACI scores and 2-year all-cause mortality. The optimal threshold, determined by the maximum Youden index from receiver operator characteristic (ROC) curve analysis, was used to stratify patients. Kaplan-Meier method was used to calculate 2-year all-cause mortality and compared using the Log-rank test. Univariate and multivariate Cox proportional hazards models were employed to calculate hazard ratios (HR) and 95% confidence intervals (CI), evaluating the association between MVACI scores and mortality. Paired ROC curves were used to compare the discriminative ability of MVACI scores with the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ) or the age-adjusted Charlson comorbidity index (ACCI) in predicting 2-year clinical outcomes, while calibration curves assessed the calibration of these models. Internal validation was performed using the Bootstrap method. Subgroup analyses were conducted based on etiology, treatment strategies, and disease severity.

Multivariate analysis identified the following variables independently associated with 2-year all-cause mortality in patients: pulmonary hypertension, myocardiopathy, heart failure, low body weight (body mass index <18.5 kg/m2), anaemia, hypoalbuminemia, renal insufficiency, cancer, New York Heart Association (NYHA) class and age. The score was independently associated with the risk of all-cause mortality, and exhibited good discrimination (AUC=0.777, 95%CI: 0.755-0.799) and calibration (Brier score 0.062), with significantly better predictive performance than EuroSCORE Ⅱ or ACCI (both adjusted P<0.01). The internal validation showed that the MVACI model's predicted probability of 2-year all-cause mortality was generally consistent with the actual probability. The AUCs for predicting all-cause mortality risk were all above 0.750, and those for predicting adverse events were all above 0.630. The prognostic value of the score remained consistent in patients regardless of their etiology, therapeutic option, and disease severity.

The MVACI was constructed in this study based on age and comorbidities, and can be used for mortality risk prediction and risk stratification of MVHD patients. It is a simple algorithmic index and easy to use.

Patients with aortic stenosis undergoing a transcatheter aortic valve replacement (TAVR) are typically discharged from hospital the next day, leaving little time to support their mobilization needs. Therefore, to improve the early mobilization of post-TAVR patients, we investigated the adoption and acceptability of a self-directed, tailored and home-based exercise program (JUMPSTART), which consists of four exercise modules, available in virtual and paper formats.

This prospective, observational, non-randomized and comparative study was conducted at one regional cardiac centre in Ontario, Canada. The development of the JUMPSTART program was informed by the Knowledge-to-Action Cycle and the choice of study outcomes were guided by the RE-AIM Framework. Program adoption and acceptability were captured through two follow-up surveys, 14-days and three-months post-TAVR; survey questions were informed by the Consolidated Framework for Implementation Research. The target program adoption rate was 70% by three-months post-TAVR. Impact of program participation on quality-of-life scores, and study participants' cardiac rehabilitation attendance, were also assessed.

There were 144 study participants. Survey response rates were 86% at 14-days post-TAVR, and 78% at three-months post-TAVR. The program adoption rate was 75% while the cardiac rehabilitation attendance rate was 30%. Approximately 70% of participants preferred the paper-based program format. The technological requirement was the most common barrier to engaging with virtual formats. Most (70%) rated the exercises as being the right level of difficulty. There were no reports of major health or safety concerns while exercising. Quality-of-life scores significantly increased from baseline to three-months post-TAVR; however, this could not be attributed to frequency of program participation. Furthermore, 73% of program participants felt that their recovery was improved because of their participation in the program, and 96% reported that they would recommend it to others. The study team regularly reviewed preliminary findings and took action to improve the program and the implementation process.

Participants were satisfied with the JUMPSTART program, which will continue to be offered to post-TAVR patients. Despite the increasing use of virtual technologies, most of this patient population prefers paper-based resources. Future planning will involve developing additional modules and exploring ways to increase program adoption, as well as cardiac rehabilitation attendance.

Not applicable.

Currently, simple clinical parameters indicating disease progression are lacking in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). This study aimed to evaluate the prognostic value of outpatient diuretic intensification (ODI) in ATTR-CM patients.

This retrospective study examined ATTR-CM patients at a tertiary care center between August 1, 2020, and June 30, 2023. ODI was defined as any loop diuretic increase within 6 months after baseline visit, and its impact on all-cause mortality and hospitalization for heart failure (HF) was analyzed.

Altogether, 182 patients were included (median age 80 [76; 84] years; 88% male), and 25% experienced ODI (median increase 10 [10; 40] mg furosemide equivalent). Independent predictors of ODI were higher baseline New York Heart Association (NYHA) class and polyneuropathy. Both any ODI and the magnitude of furosemide equivalent increase were significantly associated with mortality and HF hospitalization during a median follow-up of 17 months. After adjusting for baseline NYHA class and National Amyloidosis Centre stage, significantly increased risk of all-cause mortality (hazard ratio [HR] 2.38, 95% confidence interval [CI] 1.03-5.53; p = 0.043) and HF hospitalization (HR 3.27, 95% CI 1.41-7.60; p = 0.006) persisted in patients with ODI. Its prognostic value was similar in strata of age, ATTR subtype, previous cardiac decompensation, biomarkers, left ventricular ejection fraction, six-minute walk distance, and tafamidis treatment.

ODI occurred in one in four ATTR-CM patients within 6 months and was associated with more severe baseline amyloid organ manifestations. ODI and the magnitude of diuretic dose increase provide easily assessable clinical markers of disease progression in patient monitoring.

TAVR is preferred over surgical aortic valve replacement in frail patients with aortic stenosis. The assessment of the treatment benefit of TAVR in this population is however equivocal.

The purpose of this study was to investigate the impact of frailty on clinical and patient-reported outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).

Patients in the SCOPE I (Safety and Efficacy of the ACURATE Neo/TF Compared to the SAPIEN 3 Bioprosthesis) trial were stratified according to frailty, defined as a multicomponent index that included loss of independence criteria based on activities of daily living, lean body mass, serum albumin, and cognitive impairment or dementia. The outcomes of interest included an endpoint integrating vital and patient-reported disease-specific health status, as well as clinical efficacy according to the Valve Academic Research Consortium (VARC)-3 definition.

Among 739 randomized patients, 122 patients (16.5%) met the definition of frailty. Mean age, comorbidities, and surgical risk were comparable between groups. Patients with and without frailty had similar improvement in patient-reported health status measures after TAVR, while patients with frailty had an increased risk of VARC-3 unfavorable outcome (risk ratio: 1.38, 95% CI: towards reduced VARC-3 clinical efficacy (risk ratio: 0.82; 95% CI: 0.65-1.03) at 3 years after TAVR.

More than 1 in 6 patients with severe aortic stenosis undergoing TAVR were considered frail in the SCOPE I trial. Patients with frailty had a similar improvement in patient-reported health status measures after TAVR, but a higher risk of unfavorable outcomes throughout 3 years of follow-up.

This study aimed to investigate the complex associations of frailty and high-sensitivity C-reactive protein (hsCRP) with cardiovascular disease (CVD) through a nationwide prospective cohort, while also assessing the mediating associations.

According to critical criteria, a total of 5239 participants from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 were ultimately enrolled in this study. Frailty was evaluated by the frailty index with 40 items, and CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A restricted cubic spline model, receiver operating characteristic curves, adjusted Cox proportional hazards regression, interaction analyses and mediation analyses were performed for association exploration.

During a maximum follow-up of 7.0 years, 1204 (23.67%) people developed CVD. Both elevated hsCRP and frailty were significantly associated with CVD incidence. Compared with participants with a healthy status and low hsCRP (< 1.015 mg/L), those with a frailty status and elevated hsCRP had the highest risk of CVD (adjusted HR, 2.97; 95% CI 2.29-3.84), heart disease (adjusted HR, 2.93; 95% CI 2.16-3.96), and stroke (adjusted HR, 4.26; 95% CI 2.81-6.44), which were still robust in the subgroup analysis. Moreover, frailty significantly mediated 19.60% of the associations between hsCRP and CVD.

Combined assessment of frailty and hsCRP levels helps to better stratify the individual risk of CVD. Frailty could partly mediate the associations between hsCRP and CVD incidence.

To evaluate post-transcatheter aortic valve replacement (TAVR) physical activity and explore the factors influencing participation.

A quantitatively driven sequential explanatory mixed-methods study was performed from October 2021 to February 2022 in Shanghai, China.

The study sample comprised 195 patients who underwent TAVR (58.46% men, mean age = 74.38 years.

A cross-sectional survey was conducted to assess the extent of physical activity maintenance after TAVR via the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Preliminary factors were identified via Poisson regression. Subsequently, Fogg's behaviour model-guided targeted qualitative interviews were conducted to confirm and expand on barriers and facilitators to physical activity engagement.

93.33% of post-TAVR patients lacked regular physical activity. Fourteen barriers and facilitators were identified and grouped into motivation (health expectation, social belonging, feeling after physical activity, kinesiophobia), ability (complex forms of physical activity, misperceptions, scheduling conflicts, traffic and distance, self-regulation), and triggers (surroundings and environment, peer and family support, professional support, mobile health, internalization of exercise habits).

The study findings indicate low adherence to regular physical activity among patients post-TAVR. Intervention strategies that increase patients' motivation and ability to perform physical activity and provide appropriate triggers should be further developed.

There is an urgent need to improve patient-selection to surgical treatment in advanced ovarian cancer as our results showed that cytoreductive surgery was without effect or even detrimental in a yet unknown subgroup of women. With an ageing population, 30% of women with advanced ovarian cancer in Sweden are >75 years. Nevertheless, there are no recommendations on patient-selection, albeit treating an unselected population in a public and centralized health care setting. Little attention has been placed on frailty assessments in oncology, despite their potential to stratify the risk of adverse outcome and mortality. Consequently, we hypothesize that frailty is a predictor of poor survival.

In this Swedish multi-centre prospective cohort study, where the exposure is frailty, consecutive women with advanced ovarian cancer scheduled for surgery with curative intent are eligible for inclusion. Three different frailty instruments are evaluated preoperatively, blinded to the caregiver. The primary outcome is 2-year overall survival. With a fixed sample size of 450 patients, a two-sided α of 0.05 and β of 0.20, the study is powered to detect a difference in 2-year survival of 12.5% by frailty, assuming a 20% prevalence of frailty. The result of the study will have a direct impact on clinical management and patient-selection as the results are expected to have a high external validity. Total study-time is 5 years, with 3 years of accrual. All participating centres started accrual by September 2024. Presentation of data on primary outcome is expected 2029.

ClinicalTrials.gov NCT06298877.

Malnutrition status is an important predictor of prognosis in patients after aortic valve replacement. However, the prognostic value of malnutrition status in patients with moderate-to-severe aortic stenosis is unclear. This study aimed to evaluate the effect of malnutrition on all-cause mortality in patients with moderate-to-severe aortic stenosis using the Patient Controlled Nutritional Status (CONUT) score, nutritional risk index, and prognostic nutritional index.

A total of 536 patients with moderate-to-severe aortic stenosis were selected in the ARISTOTLE (Aortic Valve Diseases Risk Factor Assessment and Prognosis Model Construction) study conducted between January 2013 and December 2022 in 3 academic institutions. Patients were grouped according to different nutritional status assessment methods. CONUT, nutritional risk index, and prognostic nutritional index were calculated at baseline. The primary study outcome was all-cause mortality. Cox regression was used to assess the association between nutritional status and all-cause mortality. During a median 34.2-month follow-up period, a total of 120 (22.4%) patients died. All-cause mortality was significantly higher in lower prognostic nutritional index, lower nutritional risk index, and higher CONUT groups. Compared with normal nutrition, malnutrition was associated with an increased risk for all-cause death (adjusted hazard ratio for mild and moderate-severe malnutrition, respectively: 2.82 [95% CI, 1.69-4.71; P<0.001] and 3.31 [95% CI, 1.74-6.32; P<0.001] for the CONUT).

In patients with moderate or severe aortic stenosis, we found that high CONUT scores, low nutritional risk index scores, and low prognostic nutritional index scores were associated with all-cause death. The poorer the nutritional status, the greater the risk of malnutrition-related all-cause mortality.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT06069232.

Nutritional status, as one of the core characteristics of frailty, the impact of its changes on clinical outcomes in older patients following transcatheter aortic valve replacement (TAVR) remains unclear.

A retrospective cohort study.

This study included a total of 781 patients who underwent TAVR at West China Hospital between 2012 and 2022.

The average age of the patients was 72.6 years, with a mean follow-up period of 2.2 years. All patients were followed for at least one year, and their nutritional status was assessed using the Controlling Nutritional Status (CONUT) score both before TAVR and six months post-TAVR. Based on post-TAVR changes in nutritional status, patients with normal nutritional status pre-TAVR were categorized into Non-malnutrition and New malnutrition groups, while patients with malnutrition pre-TAVR were categorized into Malnutrition regression and Malnutrition persistence groups.

The New malnutrition group experienced higher cumulative incidences of all-cause mortality (20.5% vs. 2.4%, P = 0.002), MACE (25.5% vs. 23.7%, P = 0.001), and readmissions for heart failure (13.1% vs. 7.3%, P = 0.027) compared to the Non-malnutrition group. Conversely, the Malnutrition regression group showed a lower cumulative incidence of all-cause mortality (3.1% vs. 18.0%, P = 0.016) compared to the Malnutrition persistence group, although no statistically significant differences were observed in MACE (14.7% vs. 28.5%, P = 0.087) and readmissions for heart failure (7.0% vs. 8.3%, P = 0.551).

Our study indicates that deterioration in nutritional status after TAVR is associated with poorer clinical outcomes, whereas improvement is associated with better outcomes.

Purpose: CT-TAVI is a critical component of pre-TAVI assessment. The conventional method, retrospective ECG-gated scan, covering a complete cardiac cycle, measures the annulus during optimal systolic phases. Recently, prospective ECG-triggered scans acquiring images at a specific interval of the cardiac cycle were evaluated, allowing faster acquisition and lower contrast doses. Moreover, these scans might be beneficial for elderly patients, reducing the need for breath-holding and easing cooperation requirements. Still, their impact on annular measurement and procedural success has yet to be fully evaluated. Methods: This retrospective, single-center study included 419 patients who underwent CT-TAVI scans, by either prospective or retrospective scanning methods. Baseline data and calculated surgical risk scores were collected, with propensity score matching performed, followed by univariate analysis, Cox regression, and multivariable regression analysis. Results: A total of 171 patient pairs were generated via propensity score matching, ensuring that both groups had similar distributions of age (81 ± 8 years), sex (55% males), and baseline comorbidities. The patients in the prospective ECG-triggered group were exposed to a smaller amount of contrast material (40.0 ± 12 mL vs. 70.0 ± 48 mL, p < 0.001) and radiation (4.4 ± 3.6 mSv vs. 8.0 ± 10.3 mSv, p < 0.001). The prospective ECG-triggered group had a smaller aortic annulus area and diameter (426.6 ± 121.0 mm2 vs. 469.1 ± 130.8 mm2, p = 0.006 and 23.3 ± 3.2 mm vs. 24.5 ± 3.6 mm, p = 0.004) but no excess paravalvular leak was observed. Multivariable analysis showed no significant differences in mortality and composite endpoints between the two groups after 23 months of follow-up. Conclusion: Prospective ECG-triggered, ultra-fast, low-dose, high-pitch scan protocol, used in selected patients offers comparable safety and clinical procedural outcomes along with time and contrast savings.

The Simpler Modified Fried Frailty Scale (SMFFS) has recently been developed from the original Fried scale to ease its use in clinical practice, by transforming the items requiring measurements into the self-reported inquiries. Its predictive validity needs to be clarified, especially in populations with a high prevalence of frailty, such as patients with heart failure (HF). Primary aim of this study is to find out the prevalence of frailty in older patients with HF by using SMFFS and show its concordance with other frailty assessment tools. Secondary aim is to reveal whether SMFFS is useful to predict mortality in follow-up.

This is a prospective, follow-up study including older adults (≥ 65 years) with HF. SMFFS was used to assess frailty phenotype and presence of ≥ 3 items was accepted as frailty. FRAIL scale, the Study of Osteoporosis Fractures (SOF) index, and Edmonton Frailty Scale (EFS) were alternatively used to study the correlation of SMFFS with different scales. Cox-regression analysis was performed to identify whether SMFFS-defined frailty could predict mortality in follow-up, with adjusting for a list of clinical characteristics and geriatric syndromes.

Among 101 patients with HF, 44 (42.8%) were female. Mean age was 75.8 ± 7.6 and frailty prevalence was 63.4% according to SMFFS. SMFFS showed a strong correlation with the other frailty scales. In a median follow-up of 759 days, cardiomegaly, increased pulmonary artery pressure (PAP) and frailty defined by SMFFS were the only predictors of mortality in older adults with HF after adjustments for age, falls in the previous year, undernutrition, probable sarcopenia, functional impairments, and quality of life [HR (95% CI) were 3.88 (1.05-14.3), 1.05 (1.01-1.09), and 10.96 (1.07-112.05) (p = 0.027); for older age, PAP, and frailty, respectively].

As a self-reported screening tool, SMFFS was independently associated with mortality in a median follow-up of two years. Frailty assessment recommended by the guidelines for risk stratification in patients with HF seems to be more effectively integrated into routine HF practice with the use of the easy and practical SMFFS. Further large scale studies are needed to support the predictive validity of SMFFS in older patients with HF.

Transcatheter Aortic Valve Implantation (TAVI) procedures are rapidly expanding, necessitating a more extensive stratification of patients with aortic stenosis. Especially in the high-risk group, some patients fail to derive optimal or any benefits from TAVI, leading to the risk of futile interventions. Despite consensus among several experts regarding the importance of recognizing and anticipating such interventions, the definition, and predictive criteria for futility in TAVI remain ambiguous.

The purpose of this study is to explore the literature addressing the definition, predictive criteria, and medical predictive models for futility in cases of TAVI.

A scoping review was conducted by two researchers and reported in accordance with the PRISMA-ScR guidelines.

Studies addressing futility in TAVI, including definitions, predictive variables, and models, were included without restrictions on study design but were excluded study only on surgical valve replacement, valve in valve or aortic stenosis causes by other pathology than calcification.

We identified 129 studies from five key sources: CINAHL, PUBMED, the Cochrane Library, ClinicalTrials.gov, and EMBASE. The literature search was conducted in two rounds-first in February 2024 and again in October 2024-using no restrictions on the year of publication or the language of the studies. Additional references were included through cross-referencing.

The definition of futility is not unanimous, although most researchers agreed on 1-year survival as a cutoff. The majority of studies focused on single variables that can predict 1-year survival, employing either prospective or retrospective designs. Frailty was the major concept studied. Numerous predictive models have been identified, but no consensus was found.

Futility concepts generate interest in the TAVI procedure. In this review, numerous articles state that 1-year mortality serves as a cutoff to define futile procedures. Some variables, cardiac or otherwise, are independent predictors of 1-year mortality. Medical predictive models showed moderate sensitivity and specificity, except for machine learning, which shows promise for the future. However, few articles delve deeply into non-quantifiable parameters such as patient goals and objectives or ethical questions. More studies should focus on these parameters.

Background: Frailty and severe aortic stenosis (AoS) are critical conditions in older adults, both of which share pathophysiological mechanisms including chronic inflammation and calcium metabolism dysregulation, potentially influencing the development and progression of these conditions. This study aimed to analyze systemic inflammation and calcium homeostasis biomarkers and their associations with frailty in older adults with severe AoS. Methods: This prospective study included 191 patients aged ≥75 years with severe AoS who were candidates for aortic valve replacement and were evaluated at a Geriatrics Frailty Assessment and Intervention Clinic. Frailty was defined as a score ≤6 on the Short Physical Performance Battery (SPPB). Biomarkers analyzed included aortic valve calcium score, parathyroid hormone (PTH), calcidiol (vitamin D), calcium, phosphate, creatinine, interleukin-6 (IL-6), and the Systemic Immune-Inflammation Index. Multivariate logistic regression was performed to identify independent predictors of frailty. Results: Of the 191 patients studied, 53.9% were women, with a mean age of 84.1 ± 4.1 years. Frailty was identified in 28.3% of patients (mean SPPB score 7.6 ± 2.5). Statistically significant differences between frail and non-frail patients were observed for PTH (87.7 ± 61.1 pg/mL vs. 70 ± 44.4 pg/mL, p = 0.028) and IL-6 (10.4 ± 11.2 pg/mL vs. 7 ± 8.2 pg/mL, p = 0.049). Notably, in the multivariate model, IL-6 emerged as a significant independent predictor of frailty (OR 1.037; CI 1.001-1.074, p = 0.043). Conclusions: IL-6 was identified as a biomarker significantly associated with frailty in older adults with severe AoS. Evaluating IL-6 could enhance the precision of frailty assessments, complement functional measures, and support clinical decision-making in this population.

To investigate the value of body composition indices derived from pre-procedural computed tomography (CT) in predicting 1-year mortality among patients who underwent transcatheter aortic valve replacement (TAVR).

We assessed consecutive patients who underwent TAVR between June 2016 and December 2021 at a single academic medical center. Skeletal muscle and subcutaneous fat area at the T4, T12, and L3 levels on pre-procedural CT were measured. The association between body composition and 1-year mortality was evaluated using Cox proportional hazard regression analysis.

Finally, 408 patients were included (185 men and 223 women; mean age, 81.7 ± 5.1 years; range, 62-98 years). Post-procedural death occurred in 13.2% of patients. The muscle-height index and fat-height index at the L3 level were more strongly correlated with those at the T12 level (r = 0.765, p < 0.001 and r = 0.932, p < 0.001, respectively) than with those at the T4 level (r = 0.535, p < 0.001 and r = 0.895, p < 0.001, respectively). The cumulative 1-year mortality rate was highest for patients with both sarcopenia and adipopenia (26%), followed by those with adipopenia only (17%), those with sarcopenia only (12%), and those with neither sarcopenia nor adipopenia (8%, p = 0.002). Multivariable analysis revealed that body composition at the T12 level was an independent risk factor for 1-year mortality (hazard ratio: 4.09, 95% confidence interval: 2.01-8.35) in patients with both sarcopenia and adipopenia (p < 0.001).

Sarcopenia or adipopenia assessed with CT at the thoracic level may be valuable for stratifying 1-year all-cause mortality in patients who undergo TAVR.

Skeletal muscle and subcutaneous fat mass indices at the level of T12, measured on pre-procedural CT, have value for risk stratification of 1-year all-cause mortality in patients who undergo transcatheter aortic valve replacement.

Sarcopenia and adipopenia are associated with the prognosis of patients undergoing transcatheter aortic valve replacement. Body composition at the T12 level was an independent risk factor for 1-year all-cause mortality. Sarcopenia or adipopenia assessed at T12 with pre-procedural CT is valuable for risk stratification.

Frailty assessment is essential for deciding the treatment strategy for patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria has been proposed for the frailty assessment; however, it is unclear whether the criteria are useful for the risk stratification in these patients. We investigated the impact of frailty assessment using the revised J-CHS criteria on clinical outcomes in patients with AS undergoing TAVR. We examined 205 consecutive severe AS patients who underwent TAVR at two tertiary hospitals from May 2018 to December 2022. Frailty was defined by the revised J-CHS criteria (score ≥ 3) before TAVR. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE). Among the studied patients, the mean age was 84 years and 65% were female. Frailty was present in 51% of patients. During a median follow-up period of 1000 (interquartile range 677-1210) days, MACCE occurred in 22 patients. Frailty was significantly independently associated with higher risks of the MACCE adjusted for confounders related to nutritional status, severity of AS, comorbidities [hazard ratio (HR) 5.09, 95% confidence interval (CI) 1.70-15.23; HR 3.94, 95% CI 1.34-11.55; HR 3.12, 95% CI 1.14-8.53; HR 3.31, 95% CI 1.21-9.02, respectively]. Frailty determined by the revised J-CHS criteria was associated with clinical outcomes, suggesting these criteria would be useful for risk stratification in Japanese patients with AS undergoing TAVR.

To evaluate the predictive ability of traditional risk scores and frailty assessment for 30-day mortality in elderly patients undergoing cardiac surgery.

A single-center retrospective cohort study was conducted, including elderly patients (≥75 years old) who underwent cardiac surgery between January 2005 and December 2015. EuroSCORE II, STS (Society of Thoracic Surgeons) score, Charlson Comorbidity Index, and Electronic Frailty Index scores were calculated to assess their predictive ability for 30-day mortality using receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC).

A total of 203 patients were included during the study period, of whom 33% underwent isolated coronary bypass surgery. The overall 30-day mortality rate was 17.6%. Patients who died within the first 30 days exhibited higher scores on EuroSCORE II, STS, and the Electronic Frailty Index. The areas under the ROC curves were: EuroSCORE II, 0.74 (95% CI: 0.66-0.81); STS, 0.66 (95% CI: 0.57-0.77); Charlson Comorbidity Index, 0.60 (95% CI: 0.49-0.70); and Electronic Frailty Index, 0.63 (95% CI: 0.52-0.73).

In this cohort of elderly patients undergoing cardiac surgery, EuroSCORE II demonstrated the best performance in predicting 30-day mortality.

Physical prehabilitation can enhance patient resilience to surgical stress, but its effects are unclear in vulnerable and frail patients. We aimed to determine the effect of a structured exercise prehabilitation programme on the quality of recovery after cardiac surgery in vulnerable and frail participants.

This single-blinded, parallel-arm, superiority, randomised controlled trial recruited patients with a Clinical Frailty Scale of 4-6 undergoing cardiac surgery. Patients were randomised to either physical prehabilitation (twice weekly) or standard care (control); both arms received standard perioperative care. The primary outcome was Quality of Recovery-15 (QoR-15) score on the third day after surgery. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE), days alive and at home (DAH30), and the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 metric.

Of 164 randomised patients, 138 were included in the primary analysis (median age 64 [interquartile range 60-69] yr; 70% males). Compliance with the 5-week prehabilitation programme was high (82%), with no adverse exercise-induced events reported. There were no between-group differences in QoR-15 scores (median difference -3, 95% confidence interval [CI] -9 to 3), early and late MACCE, and DAH30 (P=0.779). Prehabilitated patients had lower disability levels than control patients (P=0.022) at 90 days after surgery (mean difference -9%, 95% CI -17% to -2%).

A 5-week programme of physical prehabilitation in predominately prefrail patients was safe, but it did not enhance quality of recovery scores after surgery. Prehabilitation resulted in a clinically meaningful decrease in disability scores at 90 days after surgery.

ChiCTR1800016098.

Women with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) have a higher burden of symptoms, are older at the time of the TAVR procedure, and have unique anatomic features that increase the periprocedural risk. However, long-term outcomes including mortality are favorable for women compared with men. Careful attention is needed in considering the vascular access route and choice of valve platform to mitigate complications. Large prospective trials dedicated to women undergoing TAVR are needed to investigate individual female-specific factors determining outcomes.

Frailty assessment for risk prediction is suggested in elderly patients undergoing cardiac surgery. We aimed to compare five different frailty tests.

Relation of Edmonton Frailty Score (EFS), Fried Frailty Phenotype (FFP), FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight), Katz and hand grip strength (HGS) tests to each other, postoperative outcomes and mortality rates were evaluated prospectively in 140 consecutive patients aged ≥65 years.

The median follow-up period was 880.5 (range, 0 to 1,237) days with higher EFS and FFP scores in non-survivors (p<0.05). Patients with any complication had higher EFS (p=0.002), FFP (p=0.004) and FRAIL (p=0,006) scores. Compared to non-frail patients, frail patients' NYHA capacity, EuroSCORE II and STS mortality risks were higher; hemoglobin values and HGS were lower with EFS, FFP, and FRAIL tests. Frail patients' hospitalization periods with EFS (p=0.003) and intensive care unit stay with FFP (p=0.029) were longer. No mortality was observed in non-frail patients according to the FFP test. The Kaplan-Meier (KM) log-rank survival curves showed significant differences in favor of non-frail subgroups according to EFS, FFP and HGS tests (p<0.05). Relative risks for mortality in frail and pre-frail patients were between 0.9 and 4. The FFP was the most sensitive test (area under curve=0.721). There was discordance rather than concordance among five different tests (Kappa <0.411).

For patients aged ≥65 years undergoing heart surgery the FFP can be used safely to determine non-frail patients. Although the EFS seems to be promising to identify frail patients, further large-scale studies using various tests are needed to predict an optimal cut-off value for this patient population.

To investigate the predictive value of a Short Physical Performance Battery (SPPB) for postoperative major adverse cardiovascular events(MACEs) in elderly patients undergoing major abdominal surgery and to develop a nomogram risk prediction model.

A total of 427 elderly patients aged ≥ 65 years who underwent major abdominal surgery at our hospital between June 2023 and March 2024 were selected for the study, and 416 patients were ultimately included. The preoperative SPPB score was measured, and the patients were divided into two groups: a high SPPB group (≥ 10) and a low SPPB group (< 10). The subjects' clinical datasets and postoperative major adverse cardiovascular event (MACEs) occurrence data were recorded. LASSO regression analysis was performed to screen predictor variables and develop a nomogram risk prediction model for predicting MACEs. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the model's clinical efficacy.

The incidence of postoperative MACEs in elderly patients who underwent major abdominal surgery was 5%. LASSO regression analysis revealed that arrhythmia, creatine kinase, SPPB, anesthesia duration, age, intraoperative minimum heart rate, BMI, and coronary artery disease were significant predictors of MACEs. The nomogram risk prediction model based on SPPB and clinical indicators can better predict the occurrence of MACEs and can guide preoperative interventions and help to improve perioperative management.The decision curve indicated encouraging clinical effectiveness, the calibration curve demonstrated good agreement, and the area under the curve (AUC) was 0.852 (95% CI, 0.749-0.954).

The nomogram risk prediction model based on SPPB and clinical indicators can better predict the occurrence of MACEs and can guide preoperative intervention and help to improve perioperative management.

To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults undergoing transcatheter aortic valve implantation (TAVI).

We followed the European Society of Cardiology (ESC) methodology for the development of QIs. Key domains were identified by constructing a conceptual framework for the delivery of TAVI care. A list of candidate QIs was developed by conducting a systematic review of the literature. A modified Delphi method was then used to select the final set of QIs. Finally, we mapped the QIs to the EuroHeart (European Unified Registries on Heart Care Evaluation and Randomized Trials) data standards for TAVI to ascertain the extent to which the EuroHeart TAVI registry captures information to calculate the QIs. We formed an international group of experts in quality improvement and TAVI, including representatives from the European Association of Percutaneous Cardiovascular Interventions, the European Association of Cardiovascular Imaging, and the Association of Cardiovascular Nursing and Allied Professions. In total, 27 QIs were selected across 8 domains of TAVI care, comprising 22 main (81%) and 5 secondary (19%) QIs. Of these, 19/27 (70%) are now being utilized in the EuroHeart TAVI registry.

We present the 2023 ESC QIs for TAVI, developed using a standard methodology and in collaboration with ESC Associations. The EuroHeart TAVI registry allows calculation of the majority of the QIs, which may be used for benchmarking care and quality improvement initiatives.

This systematic review and meta-analysis sought (i) to provide an overview of the incidence of delirium following open cardiac surgery and (ii) to investigate how incidences of delirium are associated with different assessment tools.

A systematic search of studies investigating delirium following open cardiac surgery was conducted in Medline (Ovid), EMBASE, PsycINFO, CiNAHL, and the Cochrane Database. Only studies with patients diagnosed or screened with a validated tool were included. Studies published from 2005-2021 were included in the meta-analysis. Of 7126 individual studies retrieved, 106 met the inclusion criteria for the meta-analysis, hereof 31% of high quality. The weighted pooled incidence of delirium following open cardiac surgery across all studies was 23% (95% CI 20-26%), however we found a considerable heterogeneity (I2 = 99%), which could not be explained by subgroups or further sensitivity analyses. The most commonly applied screening tool for delirium is CAM/CAM-ICU. The lowest estimates of delirium were found by applying the Delirium Observation Scale (incidence 14%, 95% CI 8-20%), and the highest estimates in studies using 'other' screening tools (Organic Brain Symptom Scale, Delirium Symptom Interview) with a pooled incidence of 43% (95% CI 19-66%), however, only two studies applied these.

Delirium following open cardiac surgery remains a complication with a high incidence of overall 23%, when applying a validated tool for screening or diagnosis. Nevertheless, this systematic review and meta-analyses highlight the significant inconsistency in current evidence regarding assessment tools and regimens.

Prospero CRD42020215519.

Transcatheter aortic valve implantation (TAVI) is a treatment for people with severe symptomatic aortic stenosis, particularly those living with frailty. Increasing frailty is associated with poorer outcomes post-TAVI. Comprehensive Geriatric Assessment (CGA) has been shown in other settings to improve outcomes in those with frailty, including perioperatively. This systematic review aims to determine whether CGA, or interventions targeting its components, improves outcomes for older people undergoing TAVI.

EMBASE, MEDLINE, CINAHL and Cochrane CENTRAL were searched on 09/01/23 and then the search was rerun on the 16/04/24. The review was registered on PROSPERO (CRD42022299955). Included studies had to evaluate either CGA, or a single- or multi-domain intervention targeting components of CGA, in those aged ≥ 65.

From 4091 papers, 24 met the inclusion criteria. Two studies assessed CGA pre-TAVI and reported mixed improvements in functional independence but no change in length of stay or post-operative delirium, although both studies had a serious risk of bias. Fifteen papers described an exercise-based intervention, and 1 paper detailed a Cognitive Behavioural Therapy-based intervention. Seven studies evaluated a multi-component intervention. There were conflicting results reported for the multi-component and single-component interventions. All studies had at least a moderate risk of bias.

There is a lack of evidence to determine whether CGA, or related interventions, improve outcomes for older adults undergoing-TAVI. The evidence for perioperative CGA, and the results of this review, support the need for well-designed trials evaluating whether CGA improves outcomes post-TAVI for older adults living with frailty.

Increasing evidence supports the implementation of geriatric assessment in the workup of older patients with aortic stenosis (AS). In 2012, an online European survey revealed that geriatricians were rarely involved in the assessment of candidates for transcatheter aortic valve implantation (TAVI). After a "call to action" for early involvement of geriatricians in AS evaluation, the survey was repeated in 2022. Our aim was to investigate whether geriatricians' role changed in the last decade.

Online survey conducted between December 16th, 2021, and December 15th, 2022. All members of the European Geriatric Medicine Society were invited to participate. The survey included 26 questions regarding geriatricians' experience with AS and TAVI.

Among 193 respondents (79.8% geriatricians), 73 (38%) reported to be involved in AS evaluation at least once a week. During 2 years prior to the survey, 43 (22.3%) had referred > 50% of their patients with severe AS for TAVI. Age influenced TAVI referral in a considerable proportion of respondents (36.8%). TAVI candidates were mainly referred to specialised cardiac centres with multidisciplinary teams (91.8%), including (47.2%) or not including (44.6%) a geriatrician. A total of 38.9% of respondents reported to be part of a multidisciplinary heart team. Geriatricians were less frequently involved (37%) than cardiologists (89.6%) and surgeons (53.4%) in pre-procedural TAVI management. Cardiologists were more frequently involved (85.5%) than geriatricians (33.7%) and surgeons (26.9%) in post-procedural management.

Geriatricians' involvement in AS management and multidisciplinary heart teams remains scarce. More efforts should be devoted to implement geriatricians' role in AS decision-making.

Muscle ultrasound is increasingly popular thanks to its advantages over other techniques. However, its usefulness in the diagnosis of sarcopenia in older adults with aortic stenosis (AS) has not been studied to date.

to analyze the prevalence of sarcopenia using muscle ultrasound and its impact on the health outcomes in older patients with AS.

The single-center FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry was used to study patients over 75 years with severe AS susceptible to valve replacement. Sarcopenia was suspected in those individuals with diminished grip strength, and the diagnosis was confirmed in the presence of reduced ultrasound quadriceps muscle thickness, following the recommendations of the EWGSOP2 (European-Working-Group-on-Sarcopenia-in-Older-People). The primary composite endpoint was urgent hospital admission and mortality of cardiac cause 6 months after the diagnosis.