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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Book ChapterDOI
New Challenges in Aortic Stenosis in the Elderly: From Epidemiology to TAVI
TL;DR: There are three principal causes of valvular aortic stenosis (AS): congenital, rheumatic, and degenerative, and some clinical risk factors of atherosclerosis have also been identified as risk Factors of calcific AS.
Book ChapterDOI
Frailty in Aortic Surgery
TL;DR: A surgeon may additionally perform an “eyeball test” or the “end of the bed-o-gram” that encompasses additional intangible variables in order to determine a more accurate risk assessment.
Journal ArticleDOI
The Impact of Cognitive Impairment on Clinical Outcomes After Transcatheter Aortic Valve Implantation (from a Systematic Review and Meta-Analysis).
Jack Sim,Ryan Ruiyang Ling,V S Q Neo,Felicia Liying Tan,Andie Hartanto Djohan,Leonard L.L. Yeo,Keith Chan,Yinghao Lim,Benjamin Yong-Qiang Tan,Tiong Cheng Yeo,Mark Y. Chan,Kian Keong Poh,William Wong,James Yip,Yao Feng Victor Chong,V.K. Sharma,Ivandito Kuntjoro,Ching-Hui Sia +17 more
TL;DR: In this article , the impact of pre-existing cognitive impairment on outcomes after transcatheter aortic valve implantation (TAVI) was investigated, and cognitive impairment significantly increased mortality (risk ratio 2.10, 95% confidence intervals [CIs] 1.43 to 3.08, p = 0.0002).
Journal ArticleDOI
Deleterious effects of loss of independence assessed with the KATZ index after aortic valve replacement in elderly patient
TL;DR: In elderly patients, autonomy assessment with the Katz index allows to distinguish a vulnerable population with less beneficial outcomes after aortic valve replacement.
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