Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI)

Schoenenberger, Andreas W.; Stortecky, Stefan; Neumann, Stephanie; Moser, André; Jüni, Peter; Carrel, Thierry; Huber, Christoph; Gandon, Marianne; Bischoff, Seraina; Schoenenberger, Christa-Maria; Stuck, Andreas E.; Windecker, Stephan; Wenaweser, Peter (2013). Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI). European Heart Journal, 34(9), pp. 684-692. Oxford: Oxford University Press 10.1093/eurheartj/ehs304

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Schoenenberger, Andreas; Stortecky, Stefan; Moser, André; Jüni, Peter; Carrel, Thierry; Huber, Christoph; Stuck, Andreas; Windecker, Stephan and Wenaweser, Peter Martin

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:31

Last Modified:

27 Apr 2018 08:43

Publisher DOI:

10.1093/eurheartj/ehs304

PubMed ID:

23008508

Web of Science ID:

000316056300015

BORIS DOI:

10.7892/boris.11834

URI:

https://boris.unibe.ch/id/eprint/11834 (FactScience: 218084)

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