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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Frailty Assessment in the Cardiovascular Care of Older Adults
Jonathan Afilalo,Karen P. Alexander,Michael J. Mack,Mathew S. Maurer,Philip Green,Larry A. Allen,Jeffrey J. Popma,Luigi Ferrucci,Daniel E. Forman +8 more
TL;DR: This work sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice and contribute valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.
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Frailty and post-operative outcomes in older surgical patients: a systematic review.
TL;DR: Evidence is found that frailty in older-old and oldest-old surgical patients predicts post-operative mortality, complications, and prolonged length of stay, and frailty assessment may be a valuable tool in peri-operative assessment.
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Calcific aortic stenosis.
Brian R. Lindman,Marie-Annick Clavel,Patrick Mathieu,Bernard Iung,Patrizio Lancellotti,Catherine M Otto,Philippe Pibarot +6 more
TL;DR: The introduction of transcatheter AVR in the past decade has been a transformative therapeutic innovation for patients at high or prohibitive risk for surgical valve replacement, and this new technology might extend to lower-risk patients in the near future.
Journal ArticleDOI
Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study
Jonathan Afilalo,Sandra Lauck,Dae Hyun Kim,Thierry Lefèvre,Nicolo Piazza,Kevin Lachapelle,Giuseppe Martucci,Andre Lamy,Marino Labinaz,Mark D. Peterson,Rakesh C. Arora,Nicolas Noiseux,Andrew N. Rassi,Igor F. Palacios,Philippe Généreux,Brian R. Lindman,Anita W. Asgar,Caroline A. Kim,Amanda Trnkus,José A. Morais,Yves Langlois,Lawrence G. Rudski,Jean-Francois Morin,Jeffrey J. Popma,John G. Webb,Louis P. Perrault +25 more
TL;DR: A brief 4-item scale encompassing lower-extremity weakness, cognitive impairment, anemia, and hypoalbuminemia outperformed other frailty scales and is recommended for use in this setting.
Journal ArticleDOI
The impact of frailty on outcomes after cardiac surgery: A systematic review
Aresh Sepehri,Thomas Beggs,Ansar Hassan,Claudio Rigatto,Claudio Rigatto,Christine Shaw-Daigle,Navdeep Tangri,Navdeep Tangri,Rakesh C. Arora +8 more
TL;DR: Patients deemed frail, determined using an objective assessment tool, have a higher likelihood of experiencing mortality, morbidity, functional decline, and MACCE following cardiac surgery, regardless of definition.
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Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery
Martin B. Leon,Craig R. Smith,Michael J. Mack,D. Craig Miller,Jeffrey W. Moses,Lars G. Svensson,E. Murat Tuzcu,John G. Webb,Gregory P. Fontana,Raj Makkar,David L. Brown,Peter C. Block,Robert A. Guyton,Augusto D. Pichard,Joseph E. Bavaria,Howard C. Herrmann,Pamela S. Douglas,John L. Petersen,Jodi J. Akin,William N. Anderson,Duolao Wang,Stuart J. Pocock +21 more
TL;DR: In patients with severe aortic stenosis who were not suitable candidates for surgery, TAVI, as compared with standard therapy, significantly reduced the rates of death from any cause, the composite end point of deathFrom any cause or repeat hospitalization, and cardiac symptoms, despite the higher incidence of major strokes and major vascular events.
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