Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study.

Skaar, Elisabeth; Øksnes, Anja; Eide, Leslie Sofia Pareja; Norekvål, Tone Merete; Ranhoff, Anette Hylen; Nordrehaug, Jan Erik; Forman, Daniel Edward; Schoenenberger, Andreas W.; Hufthammer, Karl Ove; Kuiper, Karel Kier-Jan; Bleie, Øyvind; Packer, Erik Jerome Stene; Langørgen, Jørund; Haaverstad, Rune; Schaufel, Margrethe Aase (2021). Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study. Aging clinical and experimental research, 33(2), pp. 345-352. Springer 10.1007/s40520-020-01525-z

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AIMS

The objective of this study was to examine baseline frailty status (including cognitive deficits) and important clinical outcomes, to inform shared decision-making in older adults receiving transcatheter aortic valve implantation (TAVI).

METHODS AND RESULTS

We conducted a prospective, observational study of 82 TAVI patients, recruited 2013 to 2015, with 2-year follow-up. Mean age was 83 years (standard deviation (SD) 4.7). Eighteen percent of the patients were frail, as assessed with an 8-item frailty scale. Fifteen patients (18%) had a Mini-Mental Status Examination (MMSE) score below 24 points at baseline, indicating cognitive impairment or dementia and five patients had an MMSE below 20 points. Mean New York Heart Association (NYHA) class at baseline and 6 months was 2.5 (SD 0.6) and 1.4 (SD 0.6), (p < 0.001). There was no change in mean Nottingham Extended Activities of Daily Living (NEADL) scale between baseline and 6 months, 54.2 (SD 11.5) and 54.5 (SD 10.3) points, respectively, mean difference 0.3 (p = 0.7). At 2 years, six patients (7%) had died, four (5%, n = 79) lived in a nursing home, four (5%) suffered from disabling stroke, and six (7%) contracted infective endocarditis.

CONCLUSIONS

TAVI patients had improvement in symptoms and maintenance of activity of daily living at 6 months. They had low mortality and most patients lived in their own home 2 years after TAVI. Complications like death, stroke, and endocarditis occurred. Some patients had cognitive impairment before the procedure which might influence decision-making. Our findings may be used to develop pre-TAVI decision aids.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic

UniBE Contributor:

Schoenenberger, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1720-8319

Publisher:

Springer

Language:

English

Submitter:

Rebecca Rufer

Date Deposited:

22 Jul 2021 15:47

Last Modified:

22 Jul 2021 17:11

Publisher DOI:

10.1007/s40520-020-01525-z

PubMed ID:

32193850

Uncontrolled Keywords:

Activity of daily living Aortic stenosis Older adults Shared decision making TAVI

BORIS DOI:

10.48350/157612

URI:

https://boris.unibe.ch/id/eprint/157612

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