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Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living.

Published on Sep 1, 2014in Eurointervention4.018
· DOI :10.4244/EIJY14M08_03
Miriam Puls7
Estimated H-index: 7
,
Bettina Sobisiak1
Estimated H-index: 1
+ 8 AuthorsWolfgang Schillinger27
Estimated H-index: 27
Sources
Abstract
AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3%, p=0.04 for immediate procedural mortality; 17% vs. 5.8%, p=0.002 for 30-day mortality; and 23% vs. 6.4%, p<0.0001 for procedural mortality). The risk-score-based 30-day mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) reflected neither the observed 30-day mortality in both groups nor the threefold risk elevation in frail patients. In contrast, the Katz Index <6 was identified as a significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67 [95% CI: 1.7-4.3], p<0.0001). During follow-up (median observation period 537 days) 56% of frail vs. 24% of non-frail patients died. CONCLUSIONS: Frailty status measured by the Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVI-specific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.
  • References (27)
  • Citations (67)
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References27
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#1Christian Witzke (University of Giessen)H-Index: 90
#2Helge Moellmann (University of Giessen)H-Index: 40
Last. Friedrich W. Mohr (University of Giessen)H-Index: 1
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Background Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis. Methods and results A total of 13 860 consecutive patients undergoing repair for aortic valve dise...
213 CitationsSource
#1Michael Mok (Laval University)H-Index: 13
#2Luis Nombela-Franco (Laval University)H-Index: 36
Last. Josep Rodés-Cabau (Laval University)H-Index: 68
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To the Editor: Determination of individual patient risk for early-term and midterm outcomes following transcatheter aortic valve implantation (TAVI) has predominantly centered on baseline comorbidities, cardiac surgery risk algorithms, and peri-procedural complications. However, there is
16 CitationsSource
#1Fabio BariliH-Index: 16
#2Davide Pacini (UNIBO: University of Bologna)H-Index: 35
Last. Alessandro Parolari (University of Milan)H-Index: 32
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Aims The European System for Cardiac Operation Risk Evaluation (EuroSCORE) is widely used for predicting in-hospital mortality after cardiac surgery. A new score (EuroSCORE II) has been recently developed to update the previously released versions. This study was undertaken to validate EuroSCORE II, to compare its performance with the original EuroSCOREs and to evaluate the effects of the removal of those factors that were included in the score even if they were statistically non-significant. Me...
94 CitationsSource
#1A. Pieter Kappetein (EUR: Erasmus University Rotterdam)H-Index: 26
#2Stuart J. Head (EUR: Erasmus University Rotterdam)H-Index: 14
Last. Martin B. Leon (EUR: Erasmus University Rotterdam)H-Index: 151
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Objectives The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection. Background A recent study confirmed that VARC definitions have already been incorporated into clinic...
2,251 CitationsSource
#3Alec Vahanian (University of Paris)H-Index: 93
#4Ottavio Alfieri Fects (UniSR: Vita-Salute San Raffaele University)H-Index: 71
Last. Thomas WaltherH-Index: 79
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ACE : angiotensin-converting enzyme AF : atrial fibrillation aPTT : activated partial thromboplastin time AR : aortic regurgitation ARB : angiotensin receptor blockers AS : aortic stenosis AVR : aortic valve replacement BNP : B-type natriuretic peptide BSA : body surface area CABG : coronary artery bypass grafting CAD : coronary artery disease CMR : cardiac magnetic resonance CPG : Committee for Practice Guidelines CRT : cardiac resynchronization therapy CT : computed tomography EACTS : European...
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#1Philip Green (CUMC: Columbia University Medical Center)H-Index: 50
#2Abigail E. Woglom (CUMC: Columbia University Medical Center)H-Index: 2
Last. Mathew R. Williams (CUMC: Columbia University Medical Center)H-Index: 27
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#1Raj MakkarH-Index: 61
#2Gregory P. FontanaH-Index: 26
Last. Martin B. LeonH-Index: 151
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BackgroundTranscatheter aortic-valve replacement (TAVR) is the recommended therapy for patients with severe aortic stenosis who are not suitable candidates for surgery. The outcomes beyond 1 year in such patients are not known. MethodsWe randomly assigned patients to transfemoral TAVR or to standard therapy (which often included balloon aortic valvuloplasty). Data on 2-year outcomes were analyzed. ResultsA total of 358 patients underwent randomization at 21 centers. The rates of death at 2 years...
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BACKGROUND: Transcatheter aortic-valve implantation (TAVI) is an emerging intervention for the treatment of high-risk patients with severe aortic stenosis and coexisting illnesses. We report the results of a prospective multicenter study of the French national transcatheter aortic-valve implantation registry, FRANCE 2. METHODS: All TAVIs performed in France, as listed in the FRANCE 2 registry, were prospectively included in the study. The primary end point was death from any cause. RESULTS: A to...
923 CitationsSource
#1Susheel Kodali (Columbia University)H-Index: 63
#2Mathew R. Williams (Columbia University)H-Index: 43
Last. Trial InvestigatorsH-Index: 3
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The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P = 0.41) and at 2 years (Kaplan–Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P = 0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P = 0.52). At 30 days, strokes were more frequent with TAVR than with surgical replac...
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#1Stefan Stortecky (University of Bern)H-Index: 33
#2Andreas W. Schoenenberger (University of Bern)H-Index: 19
Last. Peter Wenaweser (University of Bern)H-Index: 53
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AIM: Our aim was to explore changes in nutritional and activity status of patients within 6 months after transcatheter aortic valve replacement (TAVR) and factors affecting malnutrition post-TAVR in this cohort, and to gain understanding of their lifestyle considerations. METHODS: Using a mixed methods approach, we conducted a prospective, longitudinal survey, consisting of interviews and a questionnaire, of 50 participants aged >/=70 years (mean age, 83 years; 58.0% female) undergoing TAVR. Min...
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#1Ahmed Bendary (Banha University)H-Index: 2
#2Ahmed Ramzy (Banha University)H-Index: 7
Last. Mohamed Salem (Banha University)H-Index: 2
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Background Patients with severe aortic stenosis and concomitant active cancer (AC) are considered high-risk patients and usually are not allowed to undergo surgical valve replacement. Transcatheter aortic valve replacement (TAVR) may be an attractive option for them; however, little is known about the outcomes of TAVR in this subset of complex patients. Methods and results In this meta-analysis, Medline, Cochrane Library and Scopus databases were searched (anytime up to April 2019) for studies e...
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#1Sikandar H. KhanH-Index: 2
Last. Babar A. Khan (IU: Indiana University)H-Index: 20
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BACKGROUND: The effect of delirium on physical function in patients undergoing noncardiac thoracic surgery has not been well described and may differ from that in other surgical populations. OBJECTIVE: To determine the effects of delirium on muscle strength and functional independence. The primary end point was change in Medical Research Council sum score (MRC-SS) by delirium status. METHODS: A secondary analysis of data from a clinical trial involving English-speaking adults aged 18 years or ol...
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#1Orit Kliuk-Ben Bassat (Tel Aviv Sourasky Medical Center)H-Index: 1
#2Ariel Finkelstein (Tel Aviv Sourasky Medical Center)H-Index: 23
Last. Yaron Arbel (Tel Aviv Sourasky Medical Center)H-Index: 22
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#1Shogo Fukui (Keio: Keio University)H-Index: 1
#2Michiyuki Kawakami (Keio: Keio University)H-Index: 9
Last. Meigen Liu (Keio: Keio University)H-Index: 29
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#1Jay N Patel (UIC: University of Illinois at Chicago)
#2Mansoor Ahmad (UIC: University of Illinois at Chicago)
Last. Sudhir Mungee (St. Francis Medical Center)H-Index: 1
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Abstract Frailty is associated with significant morbidity and mortality for patients undergoing transcatheter aortic valve implantation (TAVI). In addition to clinical outcomes, cost is an important factor to inform clinical decision-making around TAVI. However, the association of frailty with cost is unknown. This study tested whether frailty was associated with cost for adult patients who underwent TAVI at a moderate-volume single center between December 2012 and April 2018 (n=431). Frailty wa...
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#1Mohammad El Garhy (Minia University)
#2Tamer Owais (Cairo University)H-Index: 2
Last. Thomas KuntzeH-Index: 20
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#1Kyusup Lee (Catholic University of Korea)
#2Jung-Min Ahn (UOU: University of Ulsan)H-Index: 35
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Background Nutritional status, a key marker of patient frailty, is an important prognostic factor after transcatheter aortic valve replacement (TAVR). Few investigations have evaluated the clinical usefulness of nutritional assessment tools for predicting the risk of mortality following TAVR.
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#1Palina Piankova (JGH: Jewish General Hospital)
#2Jonathan Afilalo (JGH: Jewish General Hospital)H-Index: 30
Assessment of frailty has become engrained in the preprocedural evaluation of older adults referred for transcatheter aortic valve replacement. Addition of frailty and disability to clinical risk scores results in improved discrimination for short- and midterm mortality and identifies patients less likely to be discharged home and more likely to report worsening quality of life over the ensuing 6 to 12 months. In clinical practice, frailty can be evaluated by a tiered approach starting with a br...
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#1Shogo Fukui (Keio: Keio University)H-Index: 1
#2Michiyuki Kawakami (Keio: Keio University)H-Index: 9
Last. Meigen Liu (Keio: Keio University)H-Index: 29
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AbstractPurpose: To determine the level of limitations in activities of daily living (ADL) and instrumental ADL, and identify related factors to instrumental ADL among elderly persons with severe aortic stenosis (AS).Materials and methods: We prospectively enrolled 112 consecutive elderly persons (mean age, 84.6 ± 4.4 y) with severe AS. We assessed ADL and instrumental ADL using the Barthel index (BI) and the Frenchay activities index (FAI), respectively. Cardiac, physical, cognitive and kidney ...
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