Prevalence and Prognostic Significance of Frailty in Elderly Patients With Severe Valvular Heart Diseases

Abstract

Background Frailty is a known predictor of adverse outcomes in aortic valve replacement. However, its impact on the broader population with valvular heart disease (VHD) remains less explored. Objectives This study aimed to evaluate the prevalence of frailty across major VHD subtypes and investigate the association between frailty and adverse clinical events. Methods A total of 2,147 elderly patients with severe VHD from the China-DVD2 Study underwent the frailty assessment using the Fried, Fried+, Essential Frailty Toolset, and a simplified 4-item score. The primary outcome was a 1-year all-cause death, whereas the secondary outcome was 1-year all-cause death and heart failure hospitalization. Results The median age was 72.8 years (43.5% female). Frailty prevalence ranged from 16.8% to 39.3% and prefrailty from 50.9% to 64.5%, depending on the assessment tool. Among the evaluated scales, the simplified frailty score was the most consistent association with adverse outcomes (adjusted HR: 1.50 [95% CI: 1.25-1.81] for all-cause mortality; 1.53 [95% CI: 1.32-1.77] for the composite outcome). These associations were preserved across the exploratory subgroups and specific VHD subtypes. Adding frailty score to the European System for Cardiac Operative Risk Evaluation II improved risk stratification for all-cause mortality (C-statistic: 0.715 vs 0.668; likelihood ratio test P < 0.001) and the composite outcome (0.722 vs 0.688; likelihood ratio test P < 0.001). Conclusions Frailty is highly prevalent and independently associated with poor prognosis in severe VHD. The simplified 4-item frailty score offers a practical and incrementally valuable tool for enhancing risk stratification in routine clinical practice.