TAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series
- PMID: 38694996
- PMCID: PMC11062620
- DOI: 10.1016/j.jacadv.2024.100877
TAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series
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.
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.
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