The Trajectory of Nutritional Status and Physical Activity before and after Transcatheter Aortic Valve Implantation

Abstract

It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment—short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11–14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI −0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI −47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure.

The impact of the Naples Prognostic Score on the short- and long-term prognosis of patients undergoing transcatheter aortic valve implantation

“…Various scoring systems, assessing nutrition and physical status, have been utilized in extensive global studies, consistently associating functional and metabolic frailty with poor outcomes. [35][36][37] A comprehensive national cohort study in the United States revealed that malnutrition is a predictor of increased post-TAVI mortality, infection rates, procedural complications, hospital readmissions, and high treatment costs. 38 Additionally, the prognostic capacities of widely used indices like the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI) have been explored.…”

“…This nutritional deficiency markedly increases frailty in patients, adversely impacting their prognosis. Various scoring systems, assessing nutrition and physical status, have been utilized in extensive global studies, consistently associating functional and metabolic frailty with poor outcomes 35–37 . A comprehensive national cohort study in the United States revealed that malnutrition is a predictor of increased post-TAVI mortality, infection rates, procedural complications, hospital readmissions, and high treatment costs 38 …”

Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation

“…Last, no objective data were available on participants' physical activity to present as a baseline characteristic. However, previous studies have shown that a majority of TAVI patients do not meet the minimal physical activity guidelines [ 38 , 39 ].…”