Hospital-Acquired Functional Decline and Clinical Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation
| Autor: | Takeshi Arimitsu, Mike Saji, Aika Kozono-Ikeya, Mitsuaki Isobe, Masakazu Saitoh, Akihiro Sakuyama, Masatoshi Nagayama, Hiromichi Ueki |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Transcatheter aortic 030204 cardiovascular system & hematology Risk Assessment Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Older patients Predictive Value of Tests Interquartile range Internal medicine medicine Humans 030212 general & internal medicine Functional decline Geriatric Assessment Survival analysis Retrospective Studies Aged 80 and over Proportional hazards model business.industry Age Factors Aortic Valve Stenosis General Medicine medicine.disease Functional Status Treatment Outcome Heart Disease Risk Factors Cardiology Female Cardiology and Cardiovascular Medicine business Body mass index Kidney disease |
| Zdroj: | Circulation Journal. 84:1083-1089 |
| ISSN: | 1347-4820 1346-9843 |
| DOI: | 10.1253/circj.cj-19-1037 |
| Popis: | Background This study aimed to assess the relationship between hospital-acquired functional decline and the risk of mid-term all-cause death in older patients undergoing transcatheter aortic valve implantation (TAVI).Methods and Results:In total, 463 patients (mean age 85 years, interquartile range [IQR]: 82, 88) undergoing elective TAVI at Sakakibara Heart Institute between 2010 and 2018, who were followed up for 3 years, were enrolled in the study. Hospital-acquired functional decline after TAVI, which was defined by at least a 1-point decrease on the Short Physical Performance Battery before discharge compared to the preoperative score, was assessed. A total of 113 patients (24.4%) showed hospital-acquired functional decline after TAVI, and 50 (11.3%) patients died over a mean follow-up period of 1.9±0.8 years. Kaplan-Meier survival curves indicated that hospital-acquired functional decline was significantly associated with all-cause mortality (log-rank test, P=0.001). On multivariate Cox regression analysis, hospital-acquired functional decline was associated with a higher risk of all-cause mortality (OR 2.108, 95% CI 1.119-3.968, P=0.021) independent of sex, body mass index, advanced chronic kidney disease, and preoperative frailty, as assessed by the modified essential frail toolkit. Conclusions Hospital-acquired functional decline is associated with mid-term all-cause mortality in older patients following TAVI. Trajectory of functional status is a vital sign, and it is useful for risk stratification in older patients following TAVI. |
| Databáze: | OpenAIRE |
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