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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Journal ArticleDOI
Functional and Cognitive Decline in Patients after Transcatheter Aortic Valve Implantation.
TL;DR: The aim of this study was to compare functional and cognitive status in patients before and after TAVI, an alternative to Surgical Aortic Valve Replacement in high risk patients with symptomatic aortic valve stenosis.
Book ChapterDOI
Introduction: The Specificity of Geriatric Cardiology
TL;DR: Though atherosclerotic vascular and heart disease still represent the first cause of death in western countries, improved primary and secondary prevention of these diseases have given a substantial contribution to the remarkable prolongation of average life expectancy, which over the last two centuries has characterized the demographic transition in Western countries.
Book ChapterDOI
Statistical Modeling Adoption on the Late-Life Function and Disability Instrument Compared to Kansas City Cardiomyopathy Questionnaire
Yunkai Liu,A. Kate MacPhedran +1 more
TL;DR: It is believed that composed models based on the five domains of the Fried scale were able to demonstrate more accurate results than the traditional KCCQ approach, and low physical activity was the strongest single-frailty domain predictor.
Journal ArticleDOI
Role of psoas muscle area as an indicator of adverse outcomes after transcatheter aortic valve implantation
TL;DR: It is demonstrated that computed tomography-calculated psoas muscle index (iPMA) is a simple and objective predictor of early postoperative complications and prolonged hospital stay after TAVI, and consequently higher hospital resource costs.
Book ChapterDOI
Ethical Aspects of Interventional Cardiology in Geriatric Patients
TL;DR: The big ethical challenge for interventional cardiology is to provide the solid evidence of an overall benefit of the invasive procedure translating into an individually acceptable improved quality of life of the geriatric patient.
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