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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 Eurointervention4.02
· DOI :10.4244/EIJY14M08_03
Miriam Puls14
Estimated H-index: 14
,
Bettina Sobisiak1
Estimated H-index: 1
+ 8 AuthorsWolfgang Schillinger26
Estimated H-index: 26
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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 (64)
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References27
Newest
Published on Jun 2, 2014in European Heart Journal23.24
Christian Witzke93
Estimated H-index: 93
(University of Giessen),
Helge Moellmann39
Estimated H-index: 39
(University of Giessen)
+ 20 AuthorsRalf Zahn42
Estimated H-index: 42
(University of Giessen)
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...
Published on Feb 1, 2013in Journal of the American College of Cardiology18.64
Michael Mok12
Estimated H-index: 12
(Laval University),
Luis Nombela-Franco32
Estimated H-index: 32
(Laval University)
+ 10 AuthorsLouis Laflamme8
Estimated H-index: 8
(Laval University)
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
Published on Jan 1, 2013in European Heart Journal23.24
Fabio Barili14
Estimated H-index: 14
,
Davide Pacini34
Estimated H-index: 34
(UNIBO: University of Bologna)
+ 5 AuthorsAlessandro Parolari31
Estimated H-index: 31
(University of Milan)
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...
A. Pieter Kappetein40
Estimated H-index: 40
(Erasmus University Medical Center),
Stuart J. Head35
Estimated H-index: 35
(Erasmus University Medical Center)
+ 19 AuthorsGerrit-Anne van Es46
Estimated H-index: 46
(Erasmus University Medical Center)
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...
Published on Oct 1, 2012in European Heart Journal23.24
Alec Vahanian88
Estimated H-index: 88
(University of Paris),
Ottavio Alfieri Fects69
Estimated H-index: 69
(UniSR: Vita-Salute San Raffaele University)
+ 63 AuthorsThomas Walther77
Estimated H-index: 77
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...
Published on Sep 1, 2012in Jacc-cardiovascular Interventions9.54
Philip Green11
Estimated H-index: 11
(CUMC: Columbia University Medical Center),
Abigail Woglom2
Estimated H-index: 2
(CUMC: Columbia University Medical Center)
+ 11 AuthorsMathew R. Williams50
Estimated H-index: 50
(CUMC: Columbia University Medical Center)
Objectives This study sought to evaluate the impact of frailty in older adults undergoing transcatheter aortic valve replacement (TAVR) for symptomatic aortic stenosis. Background Frailty status impacts prognosis in older adults with heart disease; however, the impact of frailty on prognosis after TAVR is unknown. Methods Gait speed, grip strength, serum albumin, and activities of daily living status were collected at baseline and used to derive a frailty score among patients who underwent TAVR ...
Published on May 3, 2012in The New England Journal of Medicine70.67
Raj Makkar56
Estimated H-index: 56
,
Gregory P. Fontana26
Estimated H-index: 26
+ 22 AuthorsHoward C. Herrmann71
Estimated H-index: 71
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...
Published on May 3, 2012in The New England Journal of Medicine70.67
Martine Gilard44
Estimated H-index: 44
,
Hélène Eltchaninoff42
Estimated H-index: 42
+ 38 AuthorsAlain Prat26
Estimated H-index: 26
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 total...
Published on May 3, 2012in The New England Journal of Medicine70.67
Susheel Kodali59
Estimated H-index: 59
(Columbia University),
Mathew R. Williams50
Estimated H-index: 50
(Columbia University)
+ 22 AuthorsAugusto D. Pichard89
Estimated H-index: 89
(MedStar Washington Hospital Center)
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...
Published on May 1, 2012in Clinical Cardiology2.46
Philip Green11
Estimated H-index: 11
(CUMC: Columbia University Medical Center),
Abigail Woglom2
Estimated H-index: 2
(CUMC: Columbia University Medical Center)
+ 10 AuthorsMartin B. Leon146
Estimated H-index: 146
(CUMC: Columbia University Medical Center)
Background: In the transcatheter aortic valve replacement era, characterization of functional status in older adults with aortic stenosis (AS) is essential. Gait speed (GS) is emerging as a marker of frailty and predictor of outcomes in older adults undergoing cardiovascular intervention. The objective of this study was to delineate the prevalence of slow GS, evaluate the association of GS with factors used in standard cardiovascular assessments, and evaluate the association of GS with dependenc...
Cited By64
Newest
Published on Jun 16, 2019in Disability and Rehabilitation2.05
Shogo Fukui1
Estimated H-index: 1
(Keio: Keio University),
Michiyuki Kawakami8
Estimated H-index: 8
(Keio: Keio University)
+ 5 AuthorsMeigen Liu29
Estimated H-index: 29
(Keio: Keio University)
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 ...
Published on May 25, 2019in Clinical Research in Cardiology4.91
Kyusup Lee , Kyusup Lee (Catholic University of Korea)+ 10 AuthorsDae-Hee Kim23
Estimated H-index: 23
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.
Published on May 1, 2019in Journal of Cardiology2.29
Yohsuke Honda3
Estimated H-index: 3
,
Masahiro Yamawaki9
Estimated H-index: 9
+ 10 AuthorsMotoharu Araki10
Estimated H-index: 10
Abstract Background This study aimed to elucidate the prognostic value of objective nutritional status after transcatheter aortic valve replacement (TAVR). Methods This study enrolled 150 consecutive patients who underwent TAVR between February 2014 and March 2017. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score before TAVR. Patients were divided into a high CONUT score (malnutrition status >4 points, n = 30) or low CONUT score (normal nutritional status 1–...
Published on Mar 1, 2019in Internal Medicine Journal1.77
H. Adams2
Estimated H-index: 2
(St. Vincent's Health System),
Srikkumar Ashokkumar (University of Melbourne)+ 3 AuthorsS. Palmer3
Estimated H-index: 3
(University of Melbourne)
Published on Jan 31, 2019in PLOS ONE2.78
Keita Sueyoshi5
Estimated H-index: 5
(Saitama Medical University),
Yusuke Watanabe11
Estimated H-index: 11
(Saitama Medical University)
+ 3 AuthorsHirokazu Okada31
Estimated H-index: 31
(Saitama Medical University)
The long-term prognosis of patients with postoperative acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) after cardiovascular surgery is unclear. We aimed to investigate long-term renal outcomes and survival in these patients to determine the risk factors for negative outcomes. Long-term prognosis was examined in 144 hospital survivors. All patients were independent and on renal replacement therapy at hospital discharge. The median age at operation was 72.0 years, a...
Published on Jan 1, 2019
Tom Kai Ming Wang8
Estimated H-index: 8
(Auckland City Hospital),
Ralph Stewart33
Estimated H-index: 33
(Auckland City Hospital)
+ 1 AuthorsPeter Ruygrok33
Estimated H-index: 33
(Auckland City Hospital)
In the practice of clinical medicine, the benefit and risk of therapy should always be carefully evaluated before it is implemented. Modelling the risk is therefore important, particularly in high-risk procedures like cardiac surgery and interventions. Multivariate logistic regression is the most common method for developing risk models, whose performance are then assessed by discrimination and calibration methods. Risk scores have been used for over two decades in cardiac surgery; however, the ...
Published on Oct 3, 2018in Expert Review of Cardiovascular Therapy
Umair Shafique (St. Michael's Hospital), Sunita Mathur23
Estimated H-index: 23
(U of T: University of Toronto)
+ 2 AuthorsAsim N. Cheema33
Estimated H-index: 33
(St. Michael's Hospital)
ABSTRACTIntroduction: Certain frail patients fail to achieve adequate functional or mortality benefit despite successful transcatheter aortic valve replacement (TAVR). Therefore, frailty assessment methods are becoming an important tool to identify and intervene on this high-risk patient subset for improving clinical outcomes.Areas covered: The authors provide an overview of frailty and frailty assessment tools being used in clinical practice and discuss the impact of frailty on the cardiac pati...
Published on Sep 13, 2018in BioMed Research International2.20
Egle Tamuleviciute-Prasciene2
Estimated H-index: 2
(Lithuanian University of Health Sciences),
Kristina Drulyte (Lithuanian University of Health Sciences)+ 2 AuthorsBirna Bjarnason-Wehrens19
Estimated H-index: 19
(German Sport University Cologne)
The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting r...
View next paperThe impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience.