Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis
| Autor: | Bob Kiaii, Rodrigo Bagur, Janet Martin, Ava John-Baptiste, Adam Hashi, Emily Dawson, Ran Bi, Michelle Yeschin, Jessica Moodie, Zhe Li, Davy Cheng |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Transcatheter aortic Frail Elderly Subgroup analysis Cardiovascular Medicine 030204 cardiovascular system & hematology vascular surgery Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Epidemiology Humans Medicine 030212 general & internal medicine Aged business.industry valvular heart disease Aortic Valve Stenosis General Medicine Vascular surgery Prognosis medicine.disease Cardiac surgery Stenosis Treatment Outcome Meta-analysis epidemiology business cardiac surgery |
| Zdroj: | BMJ Open, Vol 11, Iss 3 (2021) BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectivesOur objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI.MethodsWe systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates.ResultsOf 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates.ConclusionsFrailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency.PROSPERO registration numberCRD42018090597. |
| Databáze: | OpenAIRE |
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