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Poor mobility predicts adverse outcome better than other frailty indices in patients undergoing transcatheter aortic valve implantation. | LitMetric

AI Article Synopsis

  • Surgical risk scores aren't great at predicting outcomes for patients getting transcatheter aortic valve implantation (TAVI), but frailty indices could be better indicators.
  • A study involving 312 TAVI patients looked at various frailty indices, finding that severe mobility issues were closely tied to worse outcomes both at 30 days and up to 5 years post-procedure.
  • The research highlights that screening for poor mobility, whether due to muscle or nerve problems, should be considered when evaluating patients for TAVI, as it is a significant predictor of survival.

Article Abstract

Background: Surgical risk scoring systems are poor at predicting outcome in patients undergoing transcatheter aortic valve implantation (TAVI). Frailty indices might more accurately predict outcome.

Aims: To examine multiple frailty indices as markers of performance to see whether they predict outcomes both in the shorter (30 days) and longer terms (5 years) in patients who have undergone TAVI.

Methods: Frailty indices (Mobility; Brighton Mobility Index, New York Heart Association (NYHA), Karnofsky Performance Index, Canadian Study Health Association (CSHA) clinical frailty scale, and Katz Index of Dependence) were assessed in 312 consecutive TAVI patients. Mortality tracking was obtained from the Office of National Statistics as of May 2014.

Results: Mean age was 81.2 ± 7.0 years; 53.2% were male. Mean Logistic EuroSCORE and STS were 17.4 ± 9.4 and 4.6 ± 2.8, respectively. Mean peak aortic valve gradient and aortic valve area were 79.1 ± 28.0 mm Hg and 0.72 ± 0.25 cm(2) , respectively. 30-day mortality was 4.8%; long-term mortality (maximum 5.8 years, mean 2.2 ± 1.5 years) was 25.3%. Both univariate and multivariate analyses confirmed poor mobility (defined as severe impairment of mobility secondary to musculoskeletal or neurological dysfunction (Euroscore II risk)), as the best predictor of adverse outcome over both the short-term (OR 4.03, 95% CI (1.36-11.96), P = 0.012 (30 days)) and longer term (OR 2.15, 95% CI (1.33-3.48), P = 0.002, (2.2 ± 1.5 years.)).

Conclusion: Poor mobility predicts worse survival among patients undergoing TAVI, both in the shorter and longer terms. Our data suggest that mobility impairment, of either neurological or musculoskeletal etiology, is an appropriate screening measure when considering patients for TAVI.

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Source
http://dx.doi.org/10.1002/ccd.25991DOI Listing

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