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The frailty syndrome and mortality among very old patients with symptomatic severe aortic stenosis under different treatments

Published on Dec 1, 2016in International Journal of Cardiology 3.47
· DOI :10.1016/j.ijcard.2016.09.020
C. Rodriguez-Pascual8
Estimated H-index: 8
(Lincoln County Hospital),
Emilio Paredes-Galán7
Estimated H-index: 7
+ 10 AuthorsFernando Rodríguez Artalejo66
Estimated H-index: 66
(UAM: Autonomous University of Madrid)
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Abstract
Abstract Background The role of frailty as a prognostic factor in non-selected patients with symptomatic severe aortic stenosis (SAS) is still uncertain. This study aims to examine the association between the frailty syndrome and mortality among very old patients with symptomatic SAS, and to assess whether the association varies with the type of SAS treatment. Methods and results Prospective study of 606 patients aged ≥75years with symptomatic SAS, recruited from February 2010 to January 2015, who were followed up through June 2015. At baseline, frailty was defined as having at least three of the following five criteria: muscle weakness, slow gait speed, low physical activity, exhaustion, and unintentional weight loss. Statistical analyses were performed with multivariate Cox regression. At baseline, 49.3% patients were frail. During a mean follow-up of 98weeks, 35.3% of patients died. The hazard ratio (95% confidence interval) of mortality among frail versus non-frail patients was 1.83 (1.33–2.51). The corresponding results were 1.58 (1.09–2.28) among patients under medical treatment, 3.06 (1.25–7.50) in those with transcatheter aortic valve replacement, and 1.97 (0.83–4.67) in those with surgical aortic valve replacement, p for interaction=0.21. When the frailty criteria were considered separately, mortality was also higher among patients with slow gait speed [1.52 (1.05–2.19)] or low physical activity [1.35 (1.00–1.85)]. Conclusions Frailty is associated with increased mortality among patients with symptomatic SAS, and this association does not vary with the type of SAS treatment. Future studies evaluating the benefits of different treatments in SAS patients should account for baseline frailty.
  • References (46)
  • Citations (6)
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References46
Newest
Published on May 1, 2016in American Journal of Cardiology 2.84
Chiara Fraccaro16
Estimated H-index: 16
(UNIPD: University of Padua),
Giuseppe Tarantini40
Estimated H-index: 40
(UNIPD: University of Padua)
+ 12 AuthorsClaudio Grossi10
Estimated H-index: 10
The aim of this study was to analyze procedural and postprocedural outcomes of patients aged ≥80 years treated by transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) as enrolled in the OBservational Study of Effectiveness of SAVR-TAVR procedures for severe Aortic steNosis Treatment (OBSERVANT) Study. TAVI is offered to patients with aortic stenosis judged inoperable or at high surgical risk. Nevertheless, it is common clinical practice to treat elderly (≥80...
Published on Apr 5, 2016in Circulation 23.05
Joakim Alfredsson16
Estimated H-index: 16
(Linköping University),
Amanda Stebbins35
Estimated H-index: 35
(Durham University)
+ 8 AuthorsMichael J. Mack35
Estimated H-index: 35
(Scott & White Hospital)
Background Surgical risk scores do not include frailty assessments (eg, gait speed), which are of particular importance for patients with severe aortic stenosis considering transcatheter aortic val ...
Published on Apr 1, 2016in Journal of the American College of Cardiology 18.64
Suzanne V. Arnold30
Estimated H-index: 30
,
Jonathan Afilalo29
Estimated H-index: 29
+ 7 AuthorsDavid Cohen33
Estimated H-index: 33
Subashan Perera44
Estimated H-index: 44
(University of Pittsburgh),
Kushang V. Patel42
Estimated H-index: 42
(UW: University of Washington)
+ 12 AuthorsJulie Chandler34
Estimated H-index: 34
(MSD: Merck & Co.)
Background. Functional independence with aging is an important goal for individuals and society. Simple prognostic indicators can inform health promotion and care planning, but evidence is limited by heterogeneity in measures of function. Methods. We performed a pooled analysis of data from seven studies of 27,220 community-dwelling older adults aged 65 or older with baseline gait speed, followed for disability and mortality. Outcomes were incident inability or dependence on another person in ba...
Published on Sep 1, 2014in Eurointervention 4.02
Miriam Puls14
Estimated H-index: 14
,
Bettina Sobisiak1
Estimated H-index: 1
+ 8 AuthorsRalf Seipelt12
Estimated H-index: 12
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...
Published on Jul 7, 2014in European Heart Journal 23.24
Mandeep Singh45
Estimated H-index: 45
(Mayo Clinic),
Ralph Stewart33
Estimated H-index: 33
(Auckland City Hospital),
Harvey D White Mb DSc Facc116
Estimated H-index: 116
(Auckland City Hospital)
Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality. With the ageing population, the prognostic determinants among others include frailty, health status, disability, and cognition. These constructs are seldom measured and factored into clinical decision-making or evaluation of the prognosis of these at-risk older adults, especially as it relates to high-risk interventions. Addressing this need effectively requires increased awareness and their recognition by the treat...
Published on Jul 1, 2014in Jacc-cardiovascular Interventions 9.54
Brian R. Lindman20
Estimated H-index: 20
(WashU: Washington University in St. Louis),
Karen P. Alexander58
Estimated H-index: 58
(Duke University)
+ 1 AuthorsJonathan Afilalo29
Estimated H-index: 29
(McGill University)
Transcatheter aortic valve replacement (TAVR) is a transformative innovation that provides treatment for high or prohibitive surgical risk patients with symptomatic severe aortic stenosis who either were previously not referred for or were denied operative intervention. Trials have demonstrated improvements in survival and symptoms after TAVR versus medical therapy; however, there remains a sizable group of patients who die or lack improvement in quality of life soon after TAVR. This raises impo...
Published on Jun 10, 2014in Circulation 23.05
Rick A. Nishimura Mdfacc110
Estimated H-index: 110
(Mayo Clinic),
Catherine M. Otto63
Estimated H-index: 63
(UW: University of Washington)
+ 25 AuthorsPaul Sorajja40
Estimated H-index: 40
(Mayo Clinic)
Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN, FAHA, Biykem Bozkurt, MD, PhD, FACC, FAHA, Ralph G. Brindis, MD, MPH, MACC, Mark A. Creager, MD, FACC, FAHA[§§][1], Lesley H. Curtis, PhD, FAHA, David DeMets, PhD,
Published on Jun 1, 2014in Journal of the American College of Cardiology 18.64
Rick A. Nishimura Mdfacc110
Estimated H-index: 110
(Mayo Clinic),
Catherine M. Otto63
Estimated H-index: 63
(UW: University of Washington)
+ 8 AuthorsThoralf M. Sundt92
Estimated H-index: 92
(Harvard University)
The medical profession should play a central role in evaluating evidence related to drugs, devices, and procedures for detection, management, and prevention of disease. When properly applied, expert analysis of available data on the benefits and risks of these therapies and procedures can improve
Published on Jun 1, 2014in Journal of Internal Medicine 6.05
Manuel Martínez-Sellés21
Estimated H-index: 21
(UEM: European University of Madrid),
J. J. Gómez Doblas1
Estimated H-index: 1
+ 12 AuthorsPilar Carrillo16
Estimated H-index: 16
Objective To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). Study Design Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. Setting Transnational registry in Spain. Subjects We included 928 patients aged ≥80 years with severe symptomatic AS. Interventions Aortic-valve replacement (AVR), transcatheter aortic-valve implantat...
Cited By6
Newest
Published on Jul 15, 2019in Scandinavian Cardiovascular Journal 1.29
Caroline Bäck2
Estimated H-index: 2
(Copenhagen University Hospital),
Mads Hornum2
Estimated H-index: 2
(Copenhagen University Hospital)
+ 1 AuthorsChristian H. Møller13
Estimated H-index: 13
(Copenhagen University Hospital)
AbstractObjectives: Typically, patients referred to cardiac surgery are aged. Because EuroSCORE tend to overestimate and STS tend to underestimate the risk of mortality after cardiac surgery, frail...
Published on Jun 1, 2019in European Geriatric Medicine 1.23
M. Ramos1
Estimated H-index: 1
,
D. M. Quezada + 3 AuthorsR. Toro8
Estimated H-index: 8
Aim Analyse which factors could influence in earlier hospitalizations for congestive heart failure in geriatric patients with degenerative aortic stenosis.
Published on Jan 1, 2019in Revista Espanola De Cardiologia 5.13
Pablo Díez-Villanueva7
Estimated H-index: 7
,
Albert Ariza-Solé10
Estimated H-index: 10
+ 8 AuthorsHéctor Bueno50
Estimated H-index: 50
(Complutense University of Madrid)
Abstract Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could con...
Published on Jan 1, 2019in Revista Espanola De Cardiologia 5.13
Pablo Díez-Villanueva7
Estimated H-index: 7
,
Albert Ariza-Solé10
Estimated H-index: 10
+ 8 AuthorsHéctor Bueno50
Estimated H-index: 50
(Complutense University of Madrid)
espanolLa fragilidad es un sindrome clinico que ocurre durante el envejecimiento, que se caracteriza por una disminucion de la reserva fisiologica ante una situacion de estres y constituye un estado de vulnerabilidad que conlleva mayor riesgo de un resultado adverso. Su prevalencia en Espana es alta, especialmente en ancianos con comorbilidad y enfermedades cronicas. En el caso de la enfermedad cardiovascular, la fragilidad determina peores resultados clinicos, con mayor morbimortalidad en todos...
Published on Sep 13, 2018in BioMed Research International 2.20
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...
Published on Jun 1, 2017in International Journal of Cardiology 3.47
Marie-Laure Bureau2
Estimated H-index: 2
(University of Poitiers),
Evelyne Liuu1
Estimated H-index: 1
(University of Poitiers)
+ 12 AuthorsStefania Maggi48
Estimated H-index: 48
(National Research Council)
Abstract Background Selection of appropriate elderly who can benefit from transcatheter aortic valve implantation (TAVI) is challenging. We evaluated the prognosis of this procedure according to the comprehensive geriatric assessment (CGA) based on the multidimensional prognostic index (MPI). Methods Prospective observational monocentric study from January 2013 to December 2015. Consecutive patients aged ≥75 who underwent TAVI and a complete CGA were included. Baseline demographic, geriatric and...