Functionality and Outcome in Older Patients with Severe Aortic Stenosis (FOOPAS): an interdisciplinary study concept for a prospective trial

Abstract

BackgroundFrailty is a geriatric syndrome that can influence mortality and functional recovery after treatment of severe aortic stenosis (AS). The integration of standardized geriatric assessment (GA) in clinical practice is limited by a lack of consensus on how to measure it.ObjectivesThis study aims to compare the incremental predictive value of different frailty scales to predict the outcomes following surgical aortic valve replacement, transcatheter aortic valve implantation, and conservative treatment of severe AS.MethodsA prospective cohort of 300 older adults with severe AS will be assembled after standard clinical examinations and a comprehensive GA, including 18 different tests and values. Primary outcome parameters are overall mortality, cardiovascular mortality, quality of life, and functionality. Secondary parameters are overall complications, cardiovascular complications, and costs.ResultsExpected results will contribute to the growing body of evidence on frailty based on parameters that influence clinical and functional outcome in elderly patients independent of the method of treatment. The pre-procedural assessment is expected to be valuable in discriminating new post-procedural complications from simple exacerbations of pre-existing conditions. Therefore, a new frailty test which is simple and feasible for application in a clinical routine by most medical professionals, may help in identifying patients for whom further GA should be considered. Finally, such a frailty score could support heart teams to find the right treatment for patients suffering from AS.ConclusionComparison of different frailty scales has not only the goal of finding a predictive value of mortality but also to bring in a meaningful improvement for each individual patient and to avoid disability or fatal outcomes.

Katz Frailty Syndrom has no Predictive Value in Low-Risk Patients Undergoing Transcatheter Aortic Valve Implantation

“…Our data confirm that the Katz frailty syndrome is a significant indicator of mortality in patients after TAVI and these data are consistent with the results presented in previous publications and meta-analysis [11,[13][14][15][16][18][19][20]. At the same time, we showed that 1-year all-causes mortality after TAVI in high-risk and intermediate-risk patients was a significantly dependent on Katz frailty score.…”

“…However, they do not include factors such as cognitive decline and difficulties in independent daily activity, and have limitations in predicting mortality in the population of patients undergoing transcatheter aortic valve implantation (TAVI). Several studies have shown that frailty is associated with higher morbidity and all-causes mortality in patients undergoing cardiac surgery or TAVI [13][14][15][16][17]. In our group, the frailty syndrome concerned all patients, and 48% in the advanced stage.…”

“…The optimal selection of patients with severe aortic stenosis for the TAVI procedure, taking into the frailty syndrome, remains the subject of many studies and analyzes [5][6][7][8][11][12][13][14]16]. Our study shows that the stage of Katz frailty syndrome is an important parameter in the assessment of patients before TAVI and has a prognostic value in assessing the risk of death after TAVI, also in depending on the risk in STS score.…”

Multidimensional Approach to Frailty

“…Guidelines for clinical management in cardiology emphasize the need to monitor FS and search for its reversible causes in the elderly (Ponikowski et al, 2016). Despite the widespread importance of FS in clinical management, there are no explicit cardiological guidelines adopting a specific definition of FS and requirements for applying methods of its identification (Vogt et al, 2018). In cardiology, there are no standardized methods in clinical decisions-making based on FS, as it is still being diagnosed with the patient's foot-of-the-bed assessment or the so-called "eyeball test" (Bridgman et al, 2015).…”

Exercise Training for Patients With Severe Aortic Stenosis in a Convalescent Rehabilitation Ward ― A Retrospective Cohort Study ―

“…2 With regard to mortality, SAVR and TAVI result in good outcomes among older patients. 3 In contrast, some patients with AS are inoperable because of their clinical status or comorbidities, 1 and up to 40% of patients with severe AS still do not undergo SAVR or TAVI. 4 These patients may experience stroke, bone fractures resulting from falls, and disuse syndrome.…”