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MONDAY, Feb. 11, 2019 (HealthDay News) — Older patients with severe frailty undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) frequently experience subsequent functional decline or lack of improvement, according to a study published online Feb. 4 in JAMA Internal Medicine<\/i>.<\/p>\n
Dae Hyun Kim, M.D., M.P.H., Sc.D., from Harvard Medical School in Boston, and colleagues conducted a prospective cohort study with a 12-month follow-up in 246 patients (mean age, 84.2 years) undergoing TAVR or SAVR for severe aortic stenosis. Participants underwent a preoperative comprehensive geriatric assessment, and a deficit-accumulation frailty index (CGA-FI) was calculated. Self-reported ability to perform 22 activities and physical tasks was assessed at one, three, six, nine, and 12 months after the procedure.<\/p>\n
The researchers identified five trajectories based on functional status at baseline and during follow-up. There was a correlation for preoperative frailty level with a lower probability of functional improvement and a greater probability of functional decline. After TAVR, patients with a CGA-FI level of 0.51 or greater had poor or very poor trajectories (45.5 and 22.7 percent, respectively). After SAVR, a fair trajectory was seen in 71.4 percent of those with CGA-FI levels of 0.41 to 0.5. There was a correlation for postoperative delirium and major complications with functional decline after TAVR or lack of improvement after SAVR.<\/p>\n
“Our study offers insight into the role of frailty assessment in predicting heterogeneous functional trajectories,” the authors write. “Anticipated functional trajectories after the procedure should inform patient-centered shared decision making about these procedures and perioperative care to optimize functional outcomes.”<\/p>\n
Two authors disclosed financial ties to the medical device industries.<\/p>\n
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