{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T03:13:51Z","timestamp":1786331631727,"version":"build-2736575974"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007299","name":"Harvard Catalyst","doi-asserted-by":"publisher","award":["KL2 TR001100-01"],"award-info":[{"award-number":["KL2 TR001100-01"]}],"id":[{"id":"10.13039\/100007299","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1 TR001102"],"award-info":[{"award-number":["UL1 TR001102"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["T32 AG023480"],"award-info":[{"award-number":["T32 AG023480"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Current guidelines recommend considering life expectancy before aortic valve replacement (AVR). We compared the performance of a general mortality index, the Lee index, to a frailty index.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a prospective cohort study of 246 older adults undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) at a single academic medical center. We compared performance of the Lee index to a deficit accumulation frailty index (FI). Logistic regression was used to assess the association of Lee index or FI with poor outcome, defined as death or functional decline with severe symptoms at 12\u2009months. Discrimination was assessed using C-statistics.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In the overall cohort, 44 experienced poor outcome (31 deaths, 13 functional decline with severe symptoms). The risk of poor outcome by Lee index quartiles was 6.8% (reference), 17.9% (odds ratio [OR], 3.0; 95% confidence interval, [0.9\u201310.2]), 20.0% (OR 3.4; [1.0\u201311.4]), and 34.0% (OR 7.1; [2.2\u201322.6]) (p-for-trend\u2009=\u20090.001). Risk of poor outcome by FI quartiles was 3.6% (reference), 10.3% (OR 3.1; [0.6\u201315.8]), 25.0% (OR 8.8; [1.9\u201341.0]), and 37.3% (OR 15.8; [3.5\u201371.1]) (p-for-trend&lt;\u20090.001). The Lee index predicted the risk of poor outcome in the SAVR cohort Lee index (quartiles 1\u20134: 2.1, 4.0, 15.4, and 20.0%; p-for-trend\u2009=\u20090.04), but not in the TAVR cohort (quartiles 1\u20134: 27.3, 29.0, 21.3, 35.4%; p-for-trend\u2009=\u20090.42). In contrast, the FI did not predict the risk of poor outcome well in the SAVR cohort (quartiles 1\u20134: 2.3, 4.4, 15.8, and 0%; p-for-trend\u2009=\u20090.24), however in the TAVR cohort (quartiles 1\u20134: 9.1, 14.3, 29.7, and 40.7%; p-for-trend\u2009=\u20090.004). Compared to the Lee index, an FI demonstrated higher C-statistics in the overall (Lee index versus FI: 0.680 versus 0.735; <jats:italic>p<\/jats:italic>\u2009=\u20090.03) and TAVR (0.560 versus 0.644; <jats:italic>p<\/jats:italic>\u2009=\u20090.03) cohorts, but not SAVR cohort (0.724 versus 0.766; <jats:italic>p<\/jats:italic>\u2009=\u20090.09).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>While a general mortality index Lee index predicted death or functional decline with severe symptoms at 12\u2009months well among SAVR patients, the FI derived from a multi-domain geriatric assessment better informs risk-stratification for high-risk TAVR patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12877-020-1440-4","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T16:03:42Z","timestamp":1580745822000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparative utility of frailty to a general prognostic score in identifying patients at risk for poor outcomes after aortic valve replacement"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6801-5602","authenticated-orcid":false,"given":"Sandra","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Festa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Afilalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Popma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal R.","family":"Khabbaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger J.","family":"Laham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Guibone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Hyun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,2,3]]},"reference":[{"key":"1440_CR1","doi-asserted-by":"publisher","first-page":"1648","DOI":"10.1016\/j.jacc.2016.08.005","volume":"68","author":"JD Carroll","year":"2016","unstructured":"Carroll JD. 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Written informed consent was obtained from the patients. The patients received financial compensation.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Jeffrey J. Popma reports receiving grants to his institution from Medtronic, Boston Scientific, and Edwards Lifesciences, and serves on advisory boards for Boston Scientific and Edwards Lifesciences.Kimberly Guibone is an educational consultant for Medtronic.The other authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"38"}}