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
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Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation – results from the CGA-TAVI multicentre registry
Andrea Ungar,Giulio Mannarino,Nathalie van der Velde,Jan Baan,Marie-Pierre Thibodeau,Jean-Bernard Masson,Gennaro Santoro,Martijn S. van Mourik,Sofie Jansen,Cornelia Deutsch,Peter Bramlage,Jana Kurucova,Martin Thoenes,Stefania Maggi,Andreas W. Schoenenberger +14 more
TL;DR: Several aspects of the CGA have shown promise for being of use to physicians when predicting TAVI outcomes, and while the MPI may be useful in clinical practice, the SPPB may be of particular value, being simple and quick to perform.
Journal ArticleDOI
Geriatric Physiology and the Frailty Syndrome
TL;DR: This work has shown that the frailty syndrome is evolving as an important, potentially modifiable process capturing a patient's biologic age and is more predictive of adverse perioperative outcomes than chronologic age.
Journal ArticleDOI
Using a multidimensional prognostic index (MPI) based on comprehensive geriatric assessment (CGA) to predict mortality in elderly undergoing transcatheter aortic valve implantation
Marie-Laure Bureau,Evelyne Liuu,Luc Christiaens,Alberto Pilotto,Jean Mergy,Fabienne Bellarbre,Pierre Ingrand,Marc Paccalin,Alfonso J. Cruz-Jentoft,Stefania Maggi,Francesco U.S. Mattace-Raso,Maria Cristina Polidori,Daniele Sancarlo,Eva Topinkova,Gianluca Trifirò,Gianluca Trifirò +15 more
TL;DR: This study indicates that CGA based on MPI tool is accurate to predict prognosis in elderly patients undergoing TAVI procedure.
Journal ArticleDOI
Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation
Glen P. Martin,Matthew Sperrin,Peter Ludman,Mark A. de Belder,Chris P Gale,William D. Toff,Neil Moat,Uday Trivedi,Iain Buchan,Mamas A. Mamas,Mamas A. Mamas +10 more
TL;DR: Although the FRANCE‐2 and ACC models outperformed all other CPMs, the performance of current TAVI‐CPMs was low when applied to an independent cohort of T AVI patients, Hence, TAVi specific C PMs need to be derived outside populations previously used for model derivation, either by adapting existing CPMS or developing new risk scores in large national registries.
Journal ArticleDOI
Frailty and cardiovascular disease: potential role of gait speed in surgical risk stratification in older adults
TL;DR: The ability of traditional risk models to predict mortality and major morbidity in older patients being considered for cardiac surgery may improve if frailty, as measured by gait speed, is included in their assessment.
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