title: Exploring changes in functional status while waiting for transcatheter aortic valve implantation.
abstract: BACKGROUND
  Aortic stenosis (AS) is a structural heart disease primarily associated with ageing. For people with multiple co-morbidities, surgical treatment may not be a safe or feasible option. Transcatheter aortic valve implantation (TAVI) is indicated for patients with symptomatic AS who are at excessive risk for surgical valve replacement and are likely to derive significant benefit. Functional status can deteriorate during the time between referral and procedure because of the rapid disease progression of severe AS and varying wait-times for treatment in Canada.
  
  
  OBJECTIVE
  The purpose of this study was to examine changes in functional status between time of eligibility assessment and TAVI procedure date.
  
  
  METHODS
  An exploratory prospective cohort study was conducted to evaluate changes in functional status including gait speed, frailty scores and cognitive status.
  
  
  RESULTS
  Thirty-two patients participated in the study with median age 81 years. Functional status declined between time of eligibility assessment and time of TAVI: gait speed increased by an average of 0.53 s (standard deviation (SD)=1.0, p=0.01) and frailty scores increased by an average of 0.31 (SD=0.64, p=0.01). Patients waiting longer than six weeks for TAVI had a larger decline in gait speed than patients waiting less than six weeks (p=0.02). Patients living alone had a larger increase in frailty scores compared to patients living with another adult (p=0.05).
  
  
  CONCLUSIONS
  Older adults with life-limiting AS are vulnerable to changes in functional status. In the absence of TAVI wait-time benchmarks, findings may be used to facilitate individualized care and management strategies and inform health-care policy.
authors.affiliation: School of Nursing, University of British Columbia, Canada Heart Centre, St Paul's Hospital, Canada jforman@providencehealth.bc.ca.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Forman
authors.affiliation: School of Nursing, University of British Columbia, Canada.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Currie
authors.affiliation: School of Nursing, University of British Columbia, Canada Heart Centre, St Paul's Hospital, Canada.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Lauck
authors.affiliation: School of Nursing, University of British Columbia, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Baumbusch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019985:Benchmarking; D001955:British Columbia; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014463:Ultrasonography; D014850:Waiting Lists
keywords: Aortic valve disease; elderly; frailty; functional status; transcatheter aortic valve implantation