Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation

Goudzwaard, Jeannette A.; Ronde-Tillmans, Marjo J A G de; Hoorn, Fleurance E D van; Kwekkeboom, Eline H C; Lenzen, Mattie J.; Wiechen, Maarten P.H. Van; Ooms, Joris F.; Nuis, Rutger‐Jan; Mieghem, Nicolas Van; Daemen, Joost; Jaegere, Peter P.T. de; Mattace-Raso, Francesco

doi:10.1093/ageing/afaa071

Cited by 18 publications

(6 citation statements)

References 34 publications

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“…4 5 Furthermore, a recent study reported that frailty was associated with a deterioration in the quality of life 1 year after TAVR. 22 Given that CFS represents the patient's functional status similar to the 6MWT, KCCQ-OS or frailty score, we believe our finding that CFS was associated with a poor SI is consistent with prior studies. In this study, Valvular heart disease preprocedural moderate to severe MR was associated with a poor SI.…”

Section: Discussionsupporting

confidence: 90%

Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement

et al. 2021

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ObjectiveTranscatheter aortic valve replacement (TAVR) improves clinical symptoms in most patients with severe aortic stenosis (AS). However, some patients do not benefit from the symptom-reducing effects of TAVR. We assessed the predictors and clinical outcomes of poor symptomatic improvement (SI) after TAVR.MethodsA total of 1749 patients with severe symptomatic AS undergoing transfemoral TAVR were evaluated using the Japanese multicentre TAVR registry. Poor SI was defined as readmission for heart failure (HF) within 1 year after TAVR or New York Heart Association (NYHA) class ≥3 after 1 year. A logistic regression model was used to identify predictors of poor SI. One-year landmark analysis after TAVR was used to evaluate the association between poor SI and clinical outcomes.ResultsAmong the overall population (mean age, 84.5 years; female, 71.3%; mean STS score, 6.3%), 6.6% were categorised as having poor SI. Atrial fibrillation, chronic obstructive pulmonary disease, Clinical Frailty Scale ≥4, chronic kidney disease and moderate to severe mitral regurgitation were independent predictors of poor SI. One-year landmark analysis demonstrated that poor SI had a higher incidence of all-cause death and readmission for HF compared with SI (p<0.001). Poor SI with preprocedural NYHA class 2 had a worse outcome than SI with preprocedural NYHA class ≥3.ConclusionsPoor SI was associated with worse outcomes 1 year after the procedure. It had a greater impact on clinical outcomes than baseline symptoms. TAVR may be challenging for patients with many predictors of poor SI.Trial registration numberThis registry, associated with the University Hospital Medical Information Network Clinical Trials Registry, was accepted by the International Committee of Medical Journal Editors (UMIN-ID: 000020423).

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Section: Discussionsupporting

confidence: 90%

Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement

et al. 2021

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“…Kobe et al 42 assessed quality of life before and 30 days after TAVI using the Short Form-36 questionnaire; they found that at 30-day follow-up, the mean scores of all but role physical and social functioning were significantly lower for frail patients. Goudzwaard et al 63 assessed quality of life using the Euro-QoL-5-dimension (EQ-5D) scale; they found that at 12 months follow-up, the mean EQ-5D decreased while the mean EQ-Visual Analogue Scale increased.…”

Section: Resultsmentioning

confidence: 99%

Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Dawson²,

Moodie

et al. 2021

BMJ Open

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ObjectivesOur objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI.MethodsWe systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates.ResultsOf 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates.ConclusionsFrailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency.PROSPERO registration numberCRD42018090597.

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“…With the inclusion of geriatricians in the heart team, more specific attention is paid to patient perspectives and preferences, coupled with life expectancy and the influence of the frailty status (i.e. utility vs futility) [10,[20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Changes in demographics, treatment and outcomes in a consecutive cohort who underwent transcatheter aortic valve implantation between 2005 and 2020

Ronde-Tillmans¹,

Nuis²,

Goudzwaard³

et al. 2022

Neth Heart J

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Introduction Transcatheter aortic valve implantation (TAVI) has matured to the treatment of choice for most patients with aortic stenosis (AS). We sought to identify trends in patient and procedural characteristics, and clinical outcomes in all patients who underwent TAVI between 2005 and 2020. Methods A single-centre analysis was performed on 1500 consecutive patients who underwent TAVI, divided into three tertiles (T) of 500 patients treated between November 2005 and December 2014 (T1), January 2015 and May 2018 (T2) and June 2018 and April 2020 (T3). Results Over time, mean age and gender did not change (T1 to T3: 80, 80 and 79 years and 53%, 55% and 52% men, respectively), while the Society of Thoracic Surgeons risk score declined (T1: 4.5% to T3: 2.7%, p < 0.001). Use of general anaesthesia also declined over time (100%, 24% and 1% from T1 to T3) and transfemoral TAVI remained the default approach (87%, 94% and 92%). Median procedure time and contrast volume decreased significantly (186, 114 and 56 min and 120, 100 and 80 ml, respectively). Thirty-day mortality (7%, 4% and 2%), stroke (7%, 3% and 3%), need for a pacemaker (19%, 22% and 8%) and delirium (17%, 12% and 8%) improved significantly, while major bleeding/vascular complications did not change (both approximately 9%, 6% and 6%). One-year survival was 80%, 88% and 92%, respectively. Conclusion Over our 15 years’ experience, patient age remained unchanged but the patient risk profile became more favourable. Simplification of the TAVI procedure occurred in parallel with major improvement in outcomes and survival. Bleeding/vascular complications and the need for pacemaker implantation remain the Achilles’ heel of TAVI.

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Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation

Cited by 18 publications

References 34 publications

Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement

Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement

Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Changes in demographics, treatment and outcomes in a consecutive cohort who underwent transcatheter aortic valve implantation between 2005 and 2020

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