Frailty is associated with delirium and mortality after transcatheter aortic valve implantation

Abstract

ObjectiveWe hypothesised that frailty assessment is of additional value to predict delirium and mortality after transcatheter aortic valve implantation (TAVI).MethodsObservational study in 89 consecutive patients who underwent TAVI. Inclusion from November 2012 to February 2014, follow-up until April 2014. Measurement of the association of variables from frailty assessment and cardiological assessment with delirium and mortality after TAVI, respectively.ResultsIncidence of delirium after TAVI: 25/89 (28%). Variables from frailty assessment protectively associated with delirium were: Mini Mental State Examination, (OR 0.79; 95% CI 0.65 to 0.96; p=0.02), Instrumental Activities of Daily Living (OR 0.79; 95% CI 0.63 to 0.99; p=0.04) and gait speed (OR 0.05; 95% CI 0.01 to 0.50; p=0.01). Timed Up and Go was predictively associated with delirium (OR 1.14; 95% CI 1.03 to 1.26; p=0.01). From cardiological assessment, pulmonary hypertension was protectively associated with delirium (OR 0.34; 95% CI 0.12 to 0.98; p=0.05). Multivariate logistic analysis: Nagelkerke R2=0.359, Mini Mental State Examination was independently associated with delirium. Incidence of mortality: 11/89 (12%). Variables predictively associated with mortality were: the summary score Frailty Index (HR 1.66, 95% CI 1.06 to 2.60; p=0.03), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (HR 1.14, 95% CI 1.06 to 1.22; p<0.001) and complications (HR 4.81, 95% CI 1.03 to 22.38; p=0.05). Multivariate Cox proportional hazards analysis: Nagelkerke R2=0.271, Frailty Index and EuroSCORE II were independently associated with mortality.ConclusionsDelirium frequently occurs after TAVI. Variables from frailty assessment are associated with delirium and mortality, independent of cardiological assessment. Thus, frailty assessment may have additional value in the prediction of delirium and mortality after TAVI.

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

“…The majority of participants included in our meta‐analysis were derived from 2 large prospective registries, with the lack of information regarding delirium diagnostic criteria and timing of the delirium screening . Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR . Several participant‐ and procedural‐related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies.…”

“…When inclusion and exclusion criteria were applied, 31 publications remained for assessment. 6,8,9,11,17, Most included studies were observational (14 prospective, 6,17,23,[26][27][28][29][30]33,35,37,41,44,47 6 propensity matched, 22,24,25,36,40,42 10 retrospective 8,9,11,31,32,34,38,43,45,46 ), with only one randomized controlled trial. 39 Differences in the differential diagnosis between POD and other comparable cognitive disorders, including dementia, depression, and schizophrenia, are summarized in Table 1.…”

“…29,45 Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR. 6,8,9,11,17,[22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]46,47 Several participant-and procedural-related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies. Larger studies are needed to identify clinical and procedural predictors of change in cognitive status early after TAVR, and to evaluate nonpharmacological strategies to reduce the incidence of IHPOD after TAVR.…”

“…Studies have generally shown no change in cognition or cognitive improvement at 3 to 6 months follow‐up after TAVR . According to other studies, in‐hospital postoperative delirium (IHPOD) is frequently observed early after TAVR and is associated with prolonged hospital stay, readmission, and mortality after TAVR, thus being an important clinical concern …”

“…[4][5][6][7] According to other studies, inhospital postoperative delirium (IHPOD) is frequently observed early after TAVR 8,9 and is associated with prolonged hospital stay, readmission, and mortality after TAVR, thus being an important clinical concern. 8, 10,11 Delirium is an acute confusional state, characterized by disturbed consciousness, altered cognition, and inattention. 12 Unlike chronic age-related cognitive dysfunction such as dementia, delirium develops over a short period of time (e.g., hours to days or months), represents a change from baseline, and tends to fluctuate during the course of the day and night.…”