Evolution of Basic Activities of Daily Living Function in Older Patients One Year After Transcatheter Aortic Valve Implantation.
Activities of Daily Living
Aged
Aortic Valve Stenosis
/ physiopathology
Cohort Studies
Female
Frail Elderly
/ statistics & numerical data
Frailty
/ diagnosis
Functional Status
Geriatric Assessment
/ methods
Heart Disease Risk Factors
Humans
Male
Preoperative Period
Prognosis
Risk Assessment
Switzerland
/ epidemiology
Transcatheter Aortic Valve Replacement
/ methods
aortic stenosis
cardiac risk scores
cognitive assessment
functional status
futility
geriatric assessment
risk stratification
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
28
05
2020
revised:
06
10
2020
accepted:
18
10
2020
pubmed:
7
11
2020
medline:
18
9
2021
entrez:
6
11
2020
Statut:
ppublish
Résumé
To assess the course and prediction of basic activities of daily living (ADL) function in patients after transcatheter aortic valve implantation (TAVI). This was a prospective cohort study. The setting was a single academic center in Switzerland. Participants included individuals aged ≥70 years (n = 330) undergoing TAVI. A frailty index (based on geriatric assessment) and cardiac risk scores (EuroSCORE, Society of Thoracic Surgeons [STS] score) were determined in patients before TAVI. Basic ADL function was measured with patient or proxy interviews at baseline and 1-year follow up. We used logistic regression models to investigate the association between baseline factors and functional decline. At 1-year follow up, 229 (69.4%) of the 330 patients had stable or improved basic ADL function, 49 (14.8%) experienced a decline in basic ADL function, and 52 (15.8%) died. The frailty index, but not cardiac risk scores, significantly predicted decline in basic ADL function. Among the 34 surviving very frail patients, 12 (35.3%) experienced a functional status decline, and the remaining 22 (64.7%) had stable or improved functional status at 1-year follow up. This study confirms that a frailty index, and not cardiac risk scores, identifies patients at an increased risk of functional status decline after TAVI. Identifying patients with a high frailty index before TAVI is clinically relevant as these patients might benefit from targeted geriatric management and rehabilitation after TAVI. However, based on current data, it is not justified to use information on frailty status as the criterion for identifying patients in whom TAVI might be futile. Although the probability of poor outcome is high, very frail patients also have a high probability of favorable long-term functional outcome.
Sections du résumé
BACKGROUND/OBJECTIVES
To assess the course and prediction of basic activities of daily living (ADL) function in patients after transcatheter aortic valve implantation (TAVI).
DESIGN
This was a prospective cohort study.
SETTING
The setting was a single academic center in Switzerland.
PARTICIPANTS
Participants included individuals aged ≥70 years (n = 330) undergoing TAVI.
MEASUREMENTS
A frailty index (based on geriatric assessment) and cardiac risk scores (EuroSCORE, Society of Thoracic Surgeons [STS] score) were determined in patients before TAVI. Basic ADL function was measured with patient or proxy interviews at baseline and 1-year follow up. We used logistic regression models to investigate the association between baseline factors and functional decline.
RESULTS
At 1-year follow up, 229 (69.4%) of the 330 patients had stable or improved basic ADL function, 49 (14.8%) experienced a decline in basic ADL function, and 52 (15.8%) died. The frailty index, but not cardiac risk scores, significantly predicted decline in basic ADL function. Among the 34 surviving very frail patients, 12 (35.3%) experienced a functional status decline, and the remaining 22 (64.7%) had stable or improved functional status at 1-year follow up.
CONCLUSION
This study confirms that a frailty index, and not cardiac risk scores, identifies patients at an increased risk of functional status decline after TAVI. Identifying patients with a high frailty index before TAVI is clinically relevant as these patients might benefit from targeted geriatric management and rehabilitation after TAVI. However, based on current data, it is not justified to use information on frailty status as the criterion for identifying patients in whom TAVI might be futile. Although the probability of poor outcome is high, very frail patients also have a high probability of favorable long-term functional outcome.
Identifiants
pubmed: 33156520
doi: 10.1111/jgs.16927
pmc: PMC7894317
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
500-505Informations de copyright
© 2020 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
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