title: Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI).
abstract: 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.
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Switzerland.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Schoenenberger
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Stephanie
authors.initials: S
authors.lastname: Neumann
authors.forename: André
authors.initials: A
authors.lastname: Moser
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.forename: Marianne
authors.initials: M
authors.lastname: Gandon
authors.forename: Seraina
authors.initials: S
authors.lastname: Bischoff
authors.forename: Christa-Maria
authors.initials: CM
authors.lastname: Schoenenberger
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Stuck
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome