Functional performance and quality of life in high-risk comorbid patients undergoing transcatheter aortic valve implantation for symptomatic aortic valve stenosis

Hiltrop, Nick; Belmans, Ann; Claes, Marie; Hornikx, Miek; Peeters, Bart; Flamaing, Johan; Adriaenssens, Tom; Praetere, Herbert De; Herregods, Marie‐Christine; Herijgers, Paul; Dubois, Christophe

doi:10.1093/ehjqcco/qcw001

Cited by 13 publications

(10 citation statements)

References 36 publications

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“…The results of the present study concur with those in the literature on overall worsening of functional status (Hiltrop et al, 2016;Miguelena-Hycka et al, 2019;Prada-Arrondo, 2021). In previous studies, functional outcomes were worse in patients with a diagnosis of cognitive decline (Bendikaite and Vimantaite, 2020).…”

Section: Discussionsupporting

confidence: 93%

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery

Harmand,

Mata,

Prada-Arrondo

et al. 2024

Front. Hum. Neurosci.

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IntroductionIn this study, we analyzed the prognostic impact of mild cognitive impairment (MCI) prior to cardiac surgery on 12-month clinical outcomes in older patients.MethodWe performed a longitudinal prospective study of 48 patients undergoing cardiac surgery and 26 neurologically healthy participants aged 65 years or older. All participants underwent a neuropsychological assessment. Functional status, quality of life and frailty were assessed in candidates for surgery. One year after surgery, 24 patients remained in the study.ResultsMild cognitive impairment (MCI) was diagnosed in 35% of the patients at baseline. Postsurgical changes in functionality consisted of a tendency toward impaired basic activities of daily living (BADL) in the MCI group and a statistically significant worsening in instrumental activities of daily living (IADL) in women with MCI. Changes in quality of life consisted of a significant improvement in anxiety-depression in the MCI group and a tendency toward greater pain-discomfort in the non-MCI group. Cognitive status significantly declined only in the non-MCI group. Neither group showed significant changes in frailty. Relative risk analysis showed that patients with a diagnosis of MCI at baseline had a higher risk of cognitive decline at follow-up, while those without a diagnosis of MCI at baseline had a lower risk of impaired IADL. No association was found between MCI and resource use. Preoperative impairment in memory, visuospatial and executive functions was significantly associated with loss of quality of life at follow-up. Impairment of memory and visuospatial function was significantly associated with cognitive decline. Preserved memory was associated with a lower risk of impaired BADL at follow-up.ConclusionThe present study provides clue on the impact of MCI in candidates for cardiac surgery. Preoperative detection of cognitive impairment could be highly valuable to help guide pre- and post-operative management.

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Section: Discussionsupporting

confidence: 93%

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery

Harmand,

Mata,

Prada-Arrondo

et al. 2024

Front. Hum. Neurosci.

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“…However, 6MWT increased significantly after 1 year in a cohort randomized to TAVI compared to no change in those randomized to medical therapy 13 , arguing against a Hawthorne effect. A second explanation for our findings is that quality of life questionnaires and 6MWT 4 produce an abundance of motivation in the hospital setting that does not correspond to daily life. In this case the findings on standard tests (6MWT, QoL questionnaires) would appear improved, whereas parameters on the health watch would remain unchanged.…”

Section: Discussionmentioning

confidence: 90%

“…1, 2 Not all TAVI patients benefit from improved physical activity as assessed by a 6-minute walking test (6MWT) or quality of life (QoL) questionnaire. 3, 4 However, these tests could be influenced by other factors and comorbidities like peripheral vascular disease for the 6MWT or depression for the QoL questionnaire. Another concern with such tools is that they merely provide a snapshot of a patient’s life, and might change under different circumstances.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Health Assessment using a wearable device before and after TAVI

Eerdekens¹,

Zelis²,

Horst

et al. 2023

Preprint

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Background: Due to the aging of the population, the prevalence of aortic valve stenosis will increase dramatically in upcoming years. Consequently Transcatheter Aortic Valve Implantation (TAVI) procedures will also expand worldwide. Optimal selection of patients who benefit with improved symptoms and prognosis is key since TAVI is not without risk. Currently we are not able to adequately predict functional outcome after TAVI. Quality of life measurement tools and traditional functional assessment tests do not always agree and can depend on factors unrelated to heart disease. Activity tracking using wearable devices might provide a more comprehensive assessment. Objectives: Identify objective parameters from a wearable device (the Philips Health Watch) associated with improvement after TAVI for severe aortic stenosis. Methods and results: 100 patients undergoing routine TAVI wore a Philips Health Watch for one week before and after the procedure. Watch data were analyzed offline: 97 before and 75 after TAVI. Parameters like the total number of steps and activity time did not change, in contrast to improvements in the six-minute walking test (6MWT) and physical limitation domain of a questionnaire (transformed WHOQOL-BREF). Conclusions: These findings in an elderly TAVI population show that watch-based parameters like the number of steps do not change after TAVI, unlike traditional 6MWT and QoL assessments that do improve. Basic wearable device parameters might be less appropriate for measurement of treatment effects from TAVI.

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“…They found that CCI scores at baseline did not appear to differ between patients who died and patients who survived at 2 years of follow-up after TAVR. [16] The difference in the number and characteristics of participants may be the main reason for the different results. Their patients had significantly lower comorbidities than our study population, including patients with both transfemoral and transapical approaches, whereas our study did not include patients with transapical approaches.…”

Section: Discussionmentioning

confidence: 99%

“…[15] However, Hiltrop et al found no difference in CCI scores between survivors and deceased populations at 2 years follow-up post-TAVR. [16] Another study also found that the CCI score was not independently associated with a higher risk of 30-day death but can be useful in addition to Logistic Euro Score (LES) and Society of Thoracic Surgeons (STS) risk models in informing decision making on the selection of patients for TAVR. [17] Furthermore, it is unknown whether Age-CCI is associated with 1-year readmission rate in patients who underwent TAVR.…”

Section: Introductionmentioning

confidence: 99%

Association of age-adjusted Charlson comorbidity index with adverse outcomes in patients undergoing transcatheter aortic valve replacement: A retrospective cohort study

Yang,

Meng,

Xin

et al. 2023

Medicine

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Patients undergoing transcatheter aortic valve replacement (TAVR) have a high comorbid burden. Our objective was to assess the association between the age-adjusted Charlson comorbidity index (Age-CCI) and mortality and readmission rates within 1-year post-TAVR. Data were extracted from the Medical Information Mart for Intensive Care IV database (MIMIC-IV version 2.0). The primary endpoint was a composite outcome of all-cause mortality or readmission within 1-year after TAVR. To examine the associations of Age-CCI with outcomes, we used multivariable Cox proportional hazards regression, restricted cubic spline (RCS), and Kaplan–Meier curves. A total of 785 patients (52.9% male) with a median age of 84.0 years were assessed. More than half of our patients had an Age-CCI ≥ 7. After adjustment for potential confounders, we found that a 1 unit increase in Age-CCI was associated with a 10% increase in mortality and readmission rates after TAVR (HR = 1.10, 95% CI: 1.04–1.17, P < .001). High Age-CCI (Age-CCI ≥ 7) compared with the low Age-CCI (Age-CCI < 7) showed a 36% increase of mortality and readmission rates (HR = 1.36, 95% CI: 1.07–1.73, P = .013). The RCS curve analysis showed a continuous linear relationship between Age-CCI and the composite outcome risk (P for non-linearity = .671). The Kaplan–Meier survival analysis showed that patients with Age-CCI ≥ 7 had a poorer prognosis than those with Age-CCI < 7 (log-rank P < .001). Subgroup analyses showed the results remained stable. Age-CCI is independently associated with all-cause mortality and readmission in patients treated with TAVR, which may help clinicians risk-stratify patients and offer an opportunity to improve patient outcomes.

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Functional performance and quality of life in high-risk comorbid patients undergoing transcatheter aortic valve implantation for symptomatic aortic valve stenosis

Cited by 13 publications

References 36 publications

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery

Influence of mild cognitive impairment on clinical and functional prognosis in older candidates for cardiac surgery

Cardiac Health Assessment using a wearable device before and after TAVI

Association of age-adjusted Charlson comorbidity index with adverse outcomes in patients undergoing transcatheter aortic valve replacement: A retrospective cohort study

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