Geriatric assessment for predicting outcomes among patients with aortic stenosis undergoing transcatheter aortic valve implantation

Abstract

Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis (AS). We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation (TAVI) and to analyze the ability of different tools for predicting clinical outcomes in this context.

Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge. The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.

Results A total of 377 patients were included (mean age of 80.4 years). Most patients were independent or mildly dependent, with an optimal cognitive status. The proportion of frailty ranged from 17.6% to 49.8%. A total of 20 patients (5.3%) died and 110/377 patients (29.2%) died or were readmitted during follow up. Overall, most components of the geriatric assessment showed an association with clinical outcomes. Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission. The association between frailty and clinical outcomes was higher for short physical performance battery (SPPB), essential frailty toolset (EFT) and the frailty index based on comprehensive geriatric assessment (IF-VIG) and lower for Fried criteria and FRAIL scale.

Conclusions AS patients from this series presented a good physical performance, optimal cognitive status and a reasonably low prevalence of frailty. The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT, SPPB and the IF-VIG.