<p>The value of screening for cognition, depression, and frailty in patients referred for TAVI</p>

Abstract

Background: Current surgical risk assessment tools fall short of appreciating geriatric risk factors including cognitive deficits, depressive, and frailty symptoms that may worsen outcomes post-transcatheter aortic valve implantation (TAVI). This study hypothesized that a screening tool, SMARTIE, would improve detection of these risks pre-TAVI, and thus be predictive of postoperative delirium (POD) and 30-day mortality post-TAVI. Design: Prospective observational cohort study, using a historical cohort for comparison. Participants: A total of 234 patients (age: 82.2±6.7 years, 59.4% male) were included. Half were screened using SMARTIE. Methods: The SMARTIE cohort was assessed for cognitive deficits and depressive symptoms using the Mini-Cog test and PHQ-2, respectively. Measures of frailty included activities of daily living inventory, the Timed Up and Go test and grip strength. For the pre-SMARTIE cohort, we extracted cognitive deficits, depression and frailty symptoms from clinic charts. The incidence of POD and 30-day mortality were recorded. Bivariate chi-square analysis or t -tests were used to report associations between SMARTIE and pre-SMARTIE groups. Multivariable logistic regression models were employed to identify independent predictors of POD and 30-day mortality. Results: More patients were identified with cognitive deficits (χ 2 =11.73, p =0.001), depressive symptoms (χ 2 =8.15, p =0.004), and physical frailty (χ 2 =5.73, p =0.017) using SMARTIE. Cognitive deficits were an independent predictor of POD (OR: 8.4, p <0.01) and 30-day mortality (OR: 4.04, p =0.03). Conclusion: This study emphasized the value of screening for geriatric risk factors prior to TAVI by demonstrating that screening increased identification of at-risk patients. It also confirmed findings that cognitive deficits are predictive of POD and mortality following TAVI.

Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study

“…32 Khan et al included TAVI patients who were screened on the presence of geriatric risk factors. 33 They found that the presence of cognitive deficits (according to the Mini-Cog test) was associated with the occurrence of a postoperative delirium and 30-day mortality. 33 A possible explanation for this finding could be that patients with cognitive impairment are more prone to develop a postoperative delirium and that this is reflected in our outcome 'major postoperative complications during hospitalisation according to the Clavien-Dindo classification' and the composite outcome.…”

“…33 They found that the presence of cognitive deficits (according to the Mini-Cog test) was associated with the occurrence of a postoperative delirium and 30-day mortality. 33 A possible explanation for this finding could be that patients with cognitive impairment are more prone to develop a postoperative delirium and that this is reflected in our outcome 'major postoperative complications during hospitalisation according to the Clavien-Dindo classification' and the composite outcome. However, only a minority (11.3%) of all patients with a Clavien-Dindo grade II complication experienced a delirium for which pharmacological treatment was necessary.…”

Validity of a novel screen for cognitive impairment and neuropsychiatric symptoms in cardiac rehabilitation

“…Given that many CR centres intake thousands of new patients each year, a comprehensive single tool that assesses common neuropsychiatric comorbidities in CVD would be less time and resource consuming in a busy clinical setting such as CR, and would be more favourable for patient acceptability to undergo testing. In support of this, previous studies have shown that a composite screen was useful in identifying neuropsychiatric comorbidities and was predictive of long-term patient outcomes including impaired functioning and poorer community integration in patients post-stroke as well as post-operative delirium and mortality in patients post-transcatheter aortic valve implantation [25–27]. Our goal was to develop a screening tool that would distinguish between CVD patients requiring referral (screen positive), those not requiring referral (screen negative) and those who need monitoring (intermediate), which could be administered in 10 min or less with minimal training.…”

Predictors of Mortality in Patients With Transcatheter Aortic Valve Implantation: A National Inpatient Sample Database Analysis

“…In order to improve patient selection and to give patients a better basis for informed decisionmaking, identifying predictors of early mortality is important [6]. TAVI has shown to reduce mortality and improve both functional status and quality of life in older patients with aortic stenosis [7]. LogisticEuroSCORE (European System for Cardiac Operative Risk Evaluation)and the Society of Thoracic Surgeons Predicted Risk of Mortality (SRS-PROM) algorithm are the two most frequently used deathprediction models [8].…”