Addressing frailty in patients undergoing TAVR

A protein supplement together with a home-based exercise intervention improved frailty measures in elderly patients undergoing transcatheter aortic valve replacement (TAVR). This intervention significantly improved strength, mobility, and balance 3 months after the procedure with a comparable effect size to a cardiac rehabilitation programme.

Frailty has been associated with poor outcomes in older adults undergoing TAVR despite high technical success in previous trials [1]. “Therefore, the conceptual framework here is to intervene on the frailty at the same time that we intervene on the heart, to move these frail patients away from poor outcomes and towards favourable outcomes,” Dr Jonathan Afilalo (McGill University, Canada) explained the aim of the PERFORM-TAVR trial (NCT03522454), which was conducted at 11 hospitals across Canada [2].

The 180 participants were ≥70 years of age (mean age 83 years) and had objective evidence of physical frailty in standardised scores. The control group received lifestyle education only, while those in the intervention group received lifestyle education in addition to a home-based exercise programme with a supervised component entailing home visits of an hour by a therapist twice a week for 12 weeks after TAVR, complemented with an unsupervised walking programme. In addition, the intervention group received a protein-rich oral nutritional supplement that they consumed twice daily starting 4 weeks before TAVR and continuing for 12 weeks after TAVR.

The primary study endpoint was the short physical performance battery (SPPB) score (range 0–12) at 12 weeks, which consists of a 3-part balance test, a gait speed test, and a chair stand test. “We're really looking at strength, mobility, and balance,” Dr Afilalo explained.

The mean SPPB score at baseline was 7.1 for both groups. At 12 weeks, it improved to 8.1 in the intervention group versus 7.1 in the control group, a multivariable-adjusted difference of 0.9 points (95% CI 0.3–1.6; P=0.006). “A 1-point improvement is approximately the same effect size observed with a full-blown cardiac rehabilitation programme. Improving frailty might improve the outcomes of patients undergoing all sorts of interventional procedures,” Dr Afilalo concluded.

1. Afilalo J, et al. J Am Coll Cardiol 2017;70:689-700.
2. Afilalo J, et al. Protein and Exercise to Reverse Frailty in Older Men and Women Undergoing Transcatheter Aortic Valve Replacement: The PERFORM-TAVR Trial. Featured Clinical Research 3, Session 413, ACC 2024 Scientific Session, 6–8 April, Atlanta, USA.

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Posted on 16 May 202413 June 2024