Background In
aortic valve disease, the relationship between claims-based
frailty indices (CFIs) and validated measures of
frailty constructed from in-person assessments is unclear but may be relevant for retrospective ascertainment of
frailty status when otherwise unmeasured. Methods and Results We linked adults aged ≥65 years in the US CoreValve Studies (linkage rate, 67%; mean age, 82.7±6.2 years, 43.1% women), to Medicare inpatient claims, 2011 to 2015. The Johns Hopkins
CFI, validated on the basis of the Fried index, was generated for each study participant, and the association between
CFI tertile and trial outcomes was evaluated as part of the EXTEND-
FRAILTY substudy. Among 2357 participants (64.9% frail), higher
CFI tertile was associated with greater impairments in nutrition, disability, cognition, and self-rated health. The primary outcome of all-cause mortality at 1 year occurred in 19.3%, 23.1%, and 31.3% of those in tertiles 1 to 3, respectively (tertile 2 versus 1: hazard ratio, 1.22; 95% CI, 0.98-1.51; P=0.07; tertile 3 versus 1: hazard ratio, 1.73; 95% CI, 1.41-2.12; P<0.001). Secondary outcomes (
bleeding, major adverse cardiovascular and cerebrovascular events, and hospitalization) were more frequent with increasing
CFI tertile and persisted despite adjustment for age, sex, New York Heart Association class, and Society of Thoracic Surgeons risk score. Conclusions In linked Medicare and CoreValve study data, a
CFI based on the Fried index consistently identified individuals with worse impairments in
frailty, disability,
cognitive dysfunction, and nutrition and a higher risk of death, hospitalization,
bleeding, and major adverse cardiovascular and cerebrovascular events, independent of age and risk category. While not a surrogate for validated metrics of
frailty using in-person assessments, use of this
CFI to ascertain
frailty status among patients with
aortic valve disease may be valid and prognostically relevant information when otherwise not measured.