Evolution of Basic Activities of Daily Living Function in Older Patients One Year After Transcatheter Aortic Valve Implantation.

Bertschi, Dominic; Moser, André; Stortecky, Stefan; Zwahlen, Marcel; Windecker, Stephan; Carrel, Thierry; Stuck, Andreas E; Schoenenberger, Andreas W (2021). Evolution of Basic Activities of Daily Living Function in Older Patients One Year After Transcatheter Aortic Valve Implantation. Journal of the American Geriatrics Society, 69(2), pp. 500-505. Wiley-Blackwell 10.1111/jgs.16927

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Bertschi, Dominic; Stortecky, Stefan; Zwahlen, Marcel; Windecker, Stephan; Carrel, Thierry; Stuck, Andreas and Schoenenberger, Andreas

Subjects:

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

ISSN:

0002-8614

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

10 Nov 2020 21:34

Last Modified:

24 Feb 2021 09:52

Publisher DOI:

10.1111/jgs.16927

PubMed ID:

33156520

Uncontrolled Keywords:

aortic stenosis cardiac risk scores cognitive assessment functional status futility geriatric assessment risk stratification

BORIS DOI:

10.7892/boris.148017

URI:

https://boris.unibe.ch/id/eprint/148017

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