Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec 12;3(2):e000478.
doi: 10.1136/openhrt-2016-000478. eCollection 2016.

Frailty is associated with delirium and mortality after transcatheter aortic valve implantation

Patricia Assmann  1 , Peter Kievit  2 , Kees van der Wulp  2 , Michel Verkroost  3 , Luc Noyez  3 , Hans Bor  4 , Yvonne Schoon  5
Affiliations

Frailty is associated with delirium and mortality after transcatheter aortic valve implantation

Patricia Assmann et al. Open Heart. .

Abstract

Objective: We hypothesised that frailty assessment is of additional value to predict delirium and mortality after transcatheter aortic valve implantation (TAVI).

Methods: Observational study in 89 consecutive patients who underwent TAVI. Inclusion from November 2012 to February 2014, follow-up until April 2014. Measurement of the association of variables from frailty assessment and cardiological assessment with delirium and mortality after TAVI, respectively.

Results: Incidence of delirium after TAVI: 25/89 (28%). Variables from frailty assessment protectively associated with delirium were: Mini Mental State Examination, (OR 0.79; 95% CI 0.65 to 0.96; p=0.02), Instrumental Activities of Daily Living (OR 0.79; 95% CI 0.63 to 0.99; p=0.04) and gait speed (OR 0.05; 95% CI 0.01 to 0.50; p=0.01). Timed Up and Go was predictively associated with delirium (OR 1.14; 95% CI 1.03 to 1.26; p=0.01). From cardiological assessment, pulmonary hypertension was protectively associated with delirium (OR 0.34; 95% CI 0.12 to 0.98; p=0.05). Multivariate logistic analysis: Nagelkerke R2=0.359, Mini Mental State Examination was independently associated with delirium. Incidence of mortality: 11/89 (12%). Variables predictively associated with mortality were: the summary score Frailty Index (HR 1.66, 95% CI 1.06 to 2.60; p=0.03), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (HR 1.14, 95% CI 1.06 to 1.22; p<0.001) and complications (HR 4.81, 95% CI 1.03 to 22.38; p=0.05). Multivariate Cox proportional hazards analysis: Nagelkerke R2=0.271, Frailty Index and EuroSCORE II were independently associated with mortality.

Conclusions: Delirium frequently occurs after TAVI. Variables from frailty assessment are associated with delirium and mortality, independent of cardiological assessment. Thus, frailty assessment may have additional value in the prediction of delirium and mortality after TAVI.

Keywords: TAVI; delirium; frailty assessment; mortality.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow chart of procedure for treatment assignment. MT, medical therapy; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.
See this image and copyright information in PMC

References

    1. Osnabrugge RL, Mylotte D, Head SJ et al. . Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol 2013;62:1002–12. 10.1016/j.jacc.2013.05.015 - DOI - PubMed
    1. Iung B, Cachier A, Baron G et al. . Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005;26:2714–20. 10.1093/eurheartj/ehi471 - DOI - PubMed
    1. Leon MB, Smith CR, Mack M et al. . Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363:1597–607. 10.1056/NEJMoa1008232 - DOI - PubMed
    1. Makkar RR, Fontana GP, Jilaihawi H et al. . Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med 2012;366:1696–704. 10.1056/NEJMoa1202277 - DOI - PubMed
    1. Kodali SK, Williams MR, Smith CR et al. . Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012;366:1686–95. 10.1056/NEJMoa1200384 - DOI - PubMed

LinkOut - more resources