Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI)
Andreas W. Schoenenberger,Stefan Stortecky,Stephanie Neumann,André Moser,Peter Jüni,Thierry Carrel,Christoph Huber,Marianne Gandon,Seraina Bischoff,Christa-Maria Schoenenberger,Andreas E. Stuck,Stephan Windecker,Peter Wenaweser +12 more
TLDR
Over a 6-month period, functional status worsened only in a minority of patients surviving TAVI, and the frailty index, but not established risk scores, was predictive of functional decline.Abstract:
Aims This study aimed to assess functional course in elderly patients undergoing transcatheter aortic valve implantation (TAVI) and to find predictors of functional decline. Methods and results In this prospective cohort, functional course was assessed in patients ≥70 years using basic activities of daily living (BADL) before and 6 months after TAVI. Baseline EuroSCORE, STS score, and a frailty index (based on assessment of cognition, mobility, nutrition, instrumental and basic activities of daily living) were evaluated to predict functional decline (deterioration in BADL) using logistic regression models. Functional decline was observed in 22 (20.8%) of 106 surviving patients. EuroSCORE (OR per 10% increase 1.18, 95% CI: 0.83-1.68, P = 0.35) and STS score (OR per 5% increase 1.64, 95% CI: 0.87-3.09, P = 0.13) weakly predicted functional decline. In contrast, the frailty index strongly predicted functional decline in univariable (OR per 1 point increase 1.57, 95% CI: 1.20-2.05, P = 0.001) and bivariable analyses (OR: 1.56, 95% CI: 1.20-2.04, P = 0.001 controlled for EuroSCORE; OR: 1.53, 95% CI: 1.17-2.02, P = 0.002 controlled for STS score). Overall predictive performance was best for the frailty index [Nagelkerke's R(2) (NR(2)) 0.135] and low for the EuroSCORE (NR(2) 0.015) and STS score (NR(2) 0.034). In univariable analyses, all components of the frailty index contributed to the prediction of functional decline. Conclusion Over a 6-month period, functional status worsened only in a minority of patients surviving TAVI. The frailty index, but not established risk scores, was predictive of functional decline. Refinement of this index might help to identify patients who potentially benefit from additional geriatric interventions after TAVI.read more
Citations
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Identification of Frailty Using a Claims-Based Frailty Index in the CoreValve Studies: Findings from the EXTEND-FRAILTY Study.
Jordan B. Strom,Jordan B. Strom,Jiaman Xu,Jiaman Xu,Ariela R. Orkaby,Ariela R. Orkaby,Changyu Shen,Changyu Shen,Brian Charest,Brian Charest,Dae Hyun Kim,Dae Hyun Kim,David Cohen,Daniel B. Kramer,Daniel B. Kramer,John A. Spertus,Robert E. Gerszten,Robert E. Gerszten,Robert W. Yeh,Robert W. Yeh +19 more
TL;DR: The relationship between claims-based frailty indices and validated measures of frailty constructed from in-person assessments is unclear but may be relev... as mentioned in this paper, but may not be relevant.
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Valvular heart disease in older adults: evolving technology to meet the needs of aging patients
TL;DR: In the elderly, goals of therapy may differ, with an emphasis placed on quality of life, functionality, maintaining independence and palliation of severe symptoms rather than increased longevity.
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Predicting and measuring mortality risk after transcatheter aortic valve replacement.
TL;DR: In this paper, transcatheter aortic valve replacement (TAVR) has emerged as a treatment option for most patients with severe symptomatic Aortic stenosis (AS) with growing indi
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The Association of Economic Outcome and Geriatric Syndromes among Older Adults with Transcatheter Aortic Valve Replacement (TAVR).
Min Ji Kwak,Rafia S. Rasu,Robert O. Morgan,Jessica Lee,Nahid J Rianon,Holly M. Holmes,Abhijeet Dhoble,Dae Hyun Kim +7 more
TL;DR: Among TAVR patients, delirium was significantly associated with increased hospital cost and LOS, and the association was significantly higher in the absence of dementia.
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