Association between frailty and long-term outcomes in patients undergoing TAVI admitted to private intensive care units in Australia

Objective Frailty is common in patients undergoing transcatheter aortic valve implantation (TAVI) and may influence post-procedural outcomes. We examined the association between frailty and long-term outcomes among patients admitted to intensive care units (ICUs) following TAVI. Design setting and participants Retrospective multicentre registry-based cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database. Adult patients (≥16 years) admitted to private ICUs in Australia following TAVI between 1 January 2018 and 30 June 2024 were included. Main outcome measures Frailty was assessed using the clinical frailty scale (CFS) and categorised as nonfrail (CFS 1–3), mildly frail (CFS 4–5), or moderately-to-severely frail (CFS 6–8). The primary outcome was survival up to 4 years. Secondary outcomes included in-hospital mortality, hospital length of stay, and discharge destination. Associations between frailty and survival were evaluated using Cox proportional hazards models with robust sandwich estimators. Results Among 3917 patients, 1598 (40.8%) were nonfrail, 1920 (49.0%) were mildly frail, and 399 (10.3%) were moderately-to-severely frail. Four-year survival was highest among nonfrail patients (73.4%; 95% confidence interval [CI], 70.1–76.8), followed by mildly frail (62.7%; 95% CI, 59.3–66.4; adjusted hazard ratio [aHR], 1.52; 95% CI, 1.33–1.73) and moderately-to-severely frail patients (44.2%; 95% CI, 37.9–51.6; aHR, 2.23; 95% CI, 1.99–2.49). Patients with moderate-to-severe frailty had higher in-hospital mortality, longer hospital stays, and less frequently discharged home. Conclusions Frailty was common among patients admitted to ICU following TAVI and was independently associated with reduced long-term survival and adverse hospital outcomes. Routine frailty assessment may help inform peri-procedural risk stratification and clinical decision-making in patients undergoing TAVI.