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.
Journal ArticleDOI
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.
References
More filters
Journal ArticleDOI
Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization.
Louise C. Walter,Richard J. Brand,Steven R. Counsell,Robert M. Palmer,C. Seth Landefeld,Richard H. Fortinsky,Kenneth E. Covinsky +6 more
TL;DR: The prognostic index, which used 6 risk factors known at discharge and a simple additive point system to stratify medical patients 70 years or older according to 1-year mortality after hospitalization, had good discrimination and calibration and generalized well in an independent sample of patients at a different site.
Journal ArticleDOI
Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery
TL;DR: Frailty screening improves risk assessment in cardiac surgery patients and may identify a subgroup of patients who may benefit from innovative processes of care, and an independent predictor of in-hospital mortality, institutional discharge, and reduced midterm survival.
Journal ArticleDOI
The Identification of Frailty:: A Systematic Literature Review
Shelley A. Sternberg,Andrea Wershof Schwartz,Sathya Karunananthan,Howard Bergman,Howard Bergman,A. Mark Clarfield,A. Mark Clarfield +6 more
TL;DR: In the 22 articles, physical function, gait speed, and cognition were the most commonly used identifying components of frailty, and death, disability, and institutionalization were common outcomes.
Journal ArticleDOI
Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials
Stefan Bachmann,Christoph Finger,Anke Huss,Matthias Egger,Andreas E. Stuck,Kerri M. Clough-Gorr +5 more
TL;DR: Inpatient rehabilitation specifically designed for geriatric patients has the potential to improve outcomes related to function, admission to nursing homes, and mortality.
Journal ArticleDOI
One year follow-up of the multi-centre European PARTNER transcatheter heart valve study
Thierry Lefèvre,Ari Pieter Kappetein,Ernst Wolner,Patrick Nataf,Martyn Thomas,Volker Schächinger,Bernard De Bruyne,Hélène Eltchaninoff,Matthias Thielmann,Dominique Himbert,Mauro Romano,Patrick W. Serruys,Gerhard Wimmer-Greinecker +12 more
TL;DR: This first team-based multi-centre European TAVI registry shows promising results in high-risk patients treated by TF or TA delivery, and Optimal patient screening, approach selection, and device refinement may improve outcomes.
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