Appropriateness of Ongoing Valve Clinic Surveillance According to Frailty Status

5017

Elnara Imanova1, Jake Wade2, Sitara Khan3

Department of Cardiology, Frimley Park Hospital

Clinical Quality

CQ - Patient Centredness

Cardiovascular

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Abstract

Introduction

Clinically significant valve disease affects 11% of people in the UK aged 65 years and older1. Frailty predicts outcomes following aortic valve replacement (AVR)2, and its assessment prior to aortic valve intervention is recommended3. For patients who have already undergone AVR and are under surveillance in a valve clinic, national guidelines highlight the importance of assessing patients factors such as frailty to determine the appropriateness of ongoing follow-up4. We evaluated the frailty status of patients who had undergone AVR and were attending the Valve Clinic at Frimley Park Hospital.

Methods

Data were collected retrospectively for 93 patients attending the Valve Clinic between February 2023 and February 2024, from the Trust’s electronic patient record system. This included data on frailty, follow-up arrangements, clinical events, and outcomes.

Results

The median patient age was 71 years; 66% male. Time since AVR ranged from 24 months to 28 years (median 5 years). Median clinical frailty scale (CFS) score was 3 (range 1-6). 90 patients (97%) had a CFS score ≤5, while 3 patients (3%) had a CFS score of 6. All 93 patients (100%) remained under valve clinic surveillance; none were discharged. 1 patient (1%) developed endocarditis and 2 (2%) required emergency cardiac admissions. 2 deaths occurred during the audit period; neither was attributable to a cardiac cause.

Conclusion

The vast majority of patients attending the valve clinic had a relatively low frailty score, meaning ongoing valve surveillance would change management. A small number of patients had a frailty score in the range where repeat valve intervention would not be considered, and therefore the appropriateness of repeated hospital attendances for echocardiography was unclear. These findings indicate that our valve clinic is aligned with BSE guidelines, which emphasise individualised surveillance to optimise outcomes and resource utilisation in valve clinics.

Authors: E Imanova; J Wade; S Khan.

Department of Cardiology, Frimley Park Hospital.

References