scholarly journals Frailty Scores and Their Utility in Older Patients with Cardiovascular Disease

2021 ◽  
Vol 16 ◽  
Author(s):  
Kenneth Jordan Ng Cheong Chung ◽  
Chris Wilkinson ◽  
Murugapathy Veerasamy ◽  
Vijay Kunadian
Keyword(s):  
Cardiovascular Disease ◽  
Older Patients ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Clinical Settings ◽  
Transcatheter Aortic Valve ◽  
Frailty Assessment ◽  
Growing Body ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The world’s population is ageing, resulting in more people with frailty receiving treatment for cardiovascular disease (CVD). The emergence of novel interventions, such as transcatheter aortic valve implantation, has also increased the proportion of older patients being treated in later stages of life. This increasing population burden makes the assessment of frailty of utmost importance, especially in patients with CVD. Despite a growing body of evidence on the association between frailty and CVD, there is no consensus on the optimal frailty assessment tool for use in clinical settings. Previous studies have shown limited concordance between validated frailty instruments. This review evaluates the evidence on the utility of frailty assessment tools in patients with CVD, and the effect of frailty on different outcomes measured.

Morphometric and traditional frailty assessment in transcatheter aortic valve implantation

2020 ◽  
Vol 21 (10) ◽  
pp. 779-786 ◽  
Author(s):  
Mohammed A. Waduud ◽  
Marilena Giannoudi ◽  
Michael Drozd ◽  
Penelope P.J. Sucharitkul ◽  
Thomas A. Slater ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Frailty Assessment ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Incidence, determinants and consequences of delirium in older patients after transcatheter aortic valve implantation

2020 ◽  
Vol 49 (3) ◽  
pp. 389-394 ◽  
Author(s):  
Jeannette A Goudzwaard ◽  
Marjo J A G de Ronde-Tillmans ◽  
Tom A J de Jager ◽  
Mattie J Lenzen ◽  
Rutger-Jan Nuis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Older Patients ◽  
Mortality Data ◽  
Transcatheter Aortic Valve ◽  
Procedural Time ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation ◽  
Negative Health Outcomes

Abstract Background delirium is an event leading to negative health outcomes and increased mortality in patients. The aim of this study is to investigate the incidence, determinants and consequences of post-operative delirium (POD) in older patients undergoing transcatheter aortic valve implantation (TAVI). Methods The TAVI Care and Cure program is a prospective, observational registry in patients referred for TAVI at Erasmus University Medical Centre. The presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and up to 3 days post-TAVI. Mortality data were obtained from the Dutch Civil Registry. Results A total of 543 patients underwent TAVI between January 2014 and December 2017. Overall, the incidence of POD was 14% (75/543 patients) but declined from 18% in 2014 to 7% in 2017 (P = 0.009). Patients who developed POD were older (81.9 ± 5.8 versus 78.6 ± 8.3 years, P < 0.001), had higher prevalence of renal dysfunction and prior stroke (54% versus 40%, P = 0.02; 31% versus 18%, P = 0.01) and were more often frail (32% versus 25%, P = 0.02). From a procedural perspective, general anesthesia (odds ratios (OR), 2.31; 95% CI, 1.40–3.83; P = 0.001), non-transfemoral access (OR, 2.37; 95% CI, 1.20–4.70; P = 0.01) and longer procedural time (OR, 1.01; 95% CI, 1.01–1.02; P < 0.001) were significantly associated with POD. One-year survival rate was 68% among patients who had suffered a POD and was 85% in patients without a POD (hazard ratio’s 1.8 (95% CI 1.01–3.10), P = 0.045). Conclusion POD frequently occurs after TAVI and is associated with increased mortality. It might be speculated that patient selection and the minimalistic approach of TAVI may reduce the frequency of delirium.

scholarly journals Short-term changes of blood pressure and aortic stiffness in older patients after transcatheter aortic valve implantation

2019 ◽  
Vol Volume 14 ◽  
pp. 1379-1386
Author(s):  
Jeannette A Goudzwaard ◽  
Eleonora Disegna ◽  
Marjo JAG de Ronde-Tillmans ◽  
Mattie J Lenzen ◽  
Peter PT de Jaegere ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Older Patients ◽  
Aortic Stiffness ◽  
Short Term ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Validation of frailty assessment batteries in relation to prognosis in older patients with cardiovascular disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Marinus ◽  
P Dendale ◽  
P Feys ◽  
R Meesen ◽  
A Timmermans ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Patients ◽  
Assessment Tool ◽  
Handgrip Strength ◽  
Mini Nutritional Assessment ◽  
Test Battery ◽  
Dominant Hand ◽  
Frailty Assessment ◽  
Frail Patients ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background Frailty is accompanied by, or can be caused by, a combination of several physical, psychosocial and cognitive problems, and is highly prevalent in older patients with cardiovascular disease (CVD). However, different frailty assessment batteries (e.g. Fried and Vigorito) remain to be compared in terms of prognosis, as well as the subcomponents within those batteries. Purpose To examine which frailty measurements contribute to the prediction of frailty in CVD patients, and prognosis, and thus should be executed in clinical settings. Methods In 133 CVD patients (mean age 78.1 ± 6.7 years) the presence of frailty was examined by the Fried criteria and compared with the outcome from the multi-component frailty assessment tool of Vigorito including the Mini Nutritional Assessment (MNA), Katz-scale, 4.6 m gait speed, Timed Up and Go Test (TUG), handgrip strength, Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and number of medications. Additional tests were executed to further enhance the prediction of frailty. Patients were followed to register hospitalisations (general and urgent) and mortality up to 6 months after the frailty assessment. First, it was then analysed whether the Fried or Vigorito test battery would equally predict complications during follow-up, and secondly a new frailty test battery was developed with evaluation towards complication risk predictions. Results According to the tool of Vigorito, significantly more CVD patients suffered from minor vs. moderate frailty (34% vs. 10%, p < 0.001) while the Phenotype of Fried did not succeed in detecting any significant difference in the number of pre-frail vs. frail patients (26% vs. 38%, p = 0.11). Moreover, the largest part of the pre-frail patients of Fried seems to be not frail according to Vigorito and the frail patients of Fried seems to be mainly minor frail according to Vigorito. Significant associations were found between hospitalisations and frailty according to Fried while mortality was significantly associated with frailty according to Vigorito and the newly developed formula (p = 0.013). Finally, based on the multivariate regression model (R2 = 0.95), sex, MNA, Katz scale, TUG, handgrip strength (dominant hand), MMSE, GDS-15, total number of medications and the interaction effect between the Katz-scale and TUG should be assessed to detect frailty.  Based on these  parameters, a new formula to detect frailty was developed (r = 0.95 with Vigorito score, p < 0.001). Conclusions In comparison with the frailty assessment tool of Vigorito, the Fried criteria may overestimate frailty and its severity. Moreover, frailty seems to be significantly associated with 6-months hospitalisations as well as with mortality. The newly developed frailty assessment battery has the potential to detect frailty in a multidimensional way, and, moreover, to predict mortality.

scholarly journals The First Experience of Aortic Valve Repeated Replacement Using the “Valve in Valve” Technique in a Patient With Dysfunction of a Biological Prosthesis

2021 ◽  
Vol 10 (3) ◽  
pp. 582-588
Author(s):  
V. V. Vladimirov ◽  
L. S. Kokov ◽  
A. I. Kovalyov ◽  
S. S. Niyazov ◽  
M. V. Parkhomenko ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Aortic Valve ◽  
Older Patients ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve ◽  
High Surgical Risk ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Introduction. Aortic valve replacement in cardiopulmonary bypass with suture fixation of the prosthesis is the “gold standard” in cardiac surgery. Currently, the frequency of use of heart valve bioprostheses is increasing in older patients. Despite all the advantages of using heart valve bioprostheses, this type of prosthesis has a major drawback - it is not durable. In most cases, the reason for the dysfunction of prostheses in the late postoperative period is early calcification of the prosthesis valves or their rupture due to degeneration. With the development of new “gentle” techniques for replacing heart valves, transcatheter aortic valve implantation was introduced into clinical practice. The use of transcatheter aortic valve implantation (TAVI) “valve in valve” for reoperations in older patients is of great interest, since in recent years the procedure has been widely used in clinical practice and shows promising data in patients with high surgical risk.Aim of study. Show first experience of using a technique «valve in valve» at N.V. Sklifosovsky Research Institute for Emergency Medicine.Material and methods. The results of surgical treatment of a patient with aortic valve bioprosthesis dysfunction using the TAVI “valve in valve” technique are presented.Results. The use of the TAVI “valve in valve” method made it possible to perform reprosthetics of the aortic valve (AV) from a transfemoral approach, not to increase the volume of intervention during reoperation, to avoid trauma to the structures of the heart and nearby tissues when accessing the AV in a patient with a high surgical risk.Conclusion. The use of the TAVI “valve in valve” method in cardiac surgery makes it possible to achieve good immediate and long-term results when it is necessary to replace the AV in patients with a high surgical risk.

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