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. 2024 Apr;3(4):100877.
doi: 10.1016/j.jacadv.2024.100877. Epub 2024 Apr 8.

TAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series

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TAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series

Abdulla A Damluji et al. JACC Adv. 2024 Apr.

Abstract

Calcific aortic stenosis can be considered a model for geriatric cardiovascular conditions due to a confluence of factors. The remarkable technological development of transcatheter aortic valve replacement was studied initially on older adult populations with prohibitive or high-risk for surgical valve replacement. Through these trials, the cardiovascular community has recognized that stratification of these chronologically older adults can be improved incrementally by invoking the concept of frailty and other geriatric risks. Given the complexity of the aging process, stratification by chronological age should only be the initial step but is no longer sufficient to optimally quantify cardiovascular and noncardiovascular risk. In this review, we employ a geriatric cardiology lens to focus on the diagnosis and the comprehensive management of aortic stenosis in older adults to enhance shared decision-making with patients and their families and optimize patient-centered outcomes. Finally, we highlight knowledge gaps that are critical for future areas of study.

Keywords: TAVR; aging; biological age; calcific aortic stenosis; chronological age; cognitive function; frailty; patient-centered outcomes; physical function; physiological age; quality of life.

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Conflict of interest statement

This study was funded in part by mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute K23-HL153771-01 (Dr Damluji). Dr Damluji has received research funding from the Pepper Scholars Program of the Johns Hopkins University Claude D. Pepper Older Americans Independence Center funded by the National Institute on Aging P30-AG021334; and has received funding from the PCORI for Live-Better Trial and the National Institute on Aging (R01-AG078153). Dr Orkaby is funded by VA CSR&D CDA-2 award IK2-CX001800 and reports consulting fees from Anthos therapeutics, unrelated to this work. Dr Kwak has received consulting fees from the Institute for Healthcare Improvement. Dr Kirkpatrick has received salary support from the NIDDK KIND-HF trial 1 R01 DK 121800-01A1. Dr Maurer has received grant support from NIH R01HL139671 and R01AG081582-01; and grants and personal fees from Alnylam, Pfizer, Eidos, and Ionis; and personal fees from Astra Zeneca, Akcea, Intellia, and Novo-Nordisk. Dr Forman has no conflicts of interest. He receives funding support from NIA R01AG058883, R01AG060499, U19AG065188, R01AG073633, R01AG077179, and P30AG024827; VA RR&D 1I21RX004409 and HSR&D1 I01 HX003518; and PCORI IHS-2021C3-24147. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

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Graphical abstract
Central Illustration
Central Illustration
The Complexity of TAVR in Older Adults With Aortic Stenosis: Moving Towards a Comprehensive Geriatric Assessment and Away from Chronological Age Comprehensive geriatric assessment along with physical frailty for older adults in (left) pre-, (middle) during, (right) post-transcatheter aortic valve replacement procedure. Addressing age-associated risks lowers the morbidity and mortality implications of falls, sarcopenia, cognitive and physical dysfunction, malnutrition, and other geriatric conditions. “What Matters Most” to older patients reflects the critical health care decisions related to the transcatheter aortic valve replacement procedure that could drive customized treatment plan to sustain and improve health at old age. Knowing and aligning care with each older patient’s priorities, values, and preferences reflects a better approach to invasive cardiovascular care and structural heart procedures. TAVR = transcatheter aortic valve replacement.
Figure 1
Figure 1
Periprocedural Code Status Practices in TAVR Programs in Washington and California Revised from Bernacki et al. TAVR = transcatheter aortic valve replacement.

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