Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 9, 2020
Date Accepted: Jun 25, 2020
Fitness-tracker assisted Frailty-Assessment before transcatheter aortic valve implantation: Proof-of-concept study
ABSTRACT
Background:
While transcatheter aortic valve replacement (TAVR) revolutionized the treatment of aortic valve stenosis, wearable health-monitoring devices are gradually transforming digital patient care.
Objective:
The study sought to develop a simple, efficient, and economical method for preprocedural frailty assessment based on parameters measured by a wearable health-monitoring device.
Methods:
This prospective study analyzed data of 50 consecutive patients (77.5 +- 5.1 years, EuroSCORE II 3.3 +- 4.1%) undergoing either transfemoral or transapical TAVR between 2017 and 2018. Every patient was fitted with a wrist-worn health-monitoring device (Garmin Vivosmart 3) for one week prior to the procedure. Twenty different parameters were measured, and threshold levels for the three most predictive categories (step count, heart rate, preprocedural stress) were calculated. Patients were assigned one point per category for exceeding the cut-off value and were then classified in four stages (no, borderline, moderate, severe frailty). Furthermore, the FIFA-score was compared to preprocedural gait speed category derived from 6-minute-walking-test (GSC-6MWT) and the Edmonton Frailty Scale classification (EFS-C). The primary study endpoint was hospital mortality.
Results:
The overall preprocedural stress level (P = .017), minutes of high stress per day (P = .019), minutes of rest per day (P = .045) and daily heart rate maximum (P = .048) as single parameters were the strongest predictors of hospital mortality. When comparing the different frailty scores, the FIFA-score demonstrated the greatest predictive power for hospital mortality (FIFA: AUC: 0.844 (0.656-1.000), P = .048; GSC-6MWT: AUC: 0.671 (0.487-0.855), P = .416; EFS-C: AUC: 0.636 (0.254-1.000), P = .436).
Conclusions:
This proof-of-concept study demonstrates the strong predictive performance of the FIFA score compared to conventional frailty assessment.
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