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

Authors :
Skaar E
Øksnes A
Eide LSP
Norekvål TM
Ranhoff AH
Nordrehaug JE
Forman DE
Schoenenberger AW
Hufthammer KO
Kuiper KK
Bleie Ø
Packer EJS
Langørgen J
Haaverstad R
Schaufel MA
Source :
Aging clinical and experimental research [Aging Clin Exp Res] 2021 Feb; Vol. 33 (2), pp. 345-352. Date of Electronic Publication: 2020 Mar 19.
Publication Year :
2021

Abstract

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).<br />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.<br />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.

Details

Language :
English
ISSN :
1720-8319
Volume :
33
Issue :
2
Database :
MEDLINE
Journal :
Aging clinical and experimental research
Publication Type :
Academic Journal
Accession number :
32193850
Full Text :
https://doi.org/10.1007/s40520-020-01525-z