Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living
2014 | journal article; research paper. A publication with affiliation to the University of Göttingen.
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Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living
Puls, M. ; Sobisiak, B.; Bleckmann, A. ; Jacobshagen, C. ; Danner, B. C. ; Huenlich, M. & Beißbarth, T. et al. (2014)
EuroIntervention, 10(5) pp. 609-619. DOI: https://doi.org/10.4244/EIJY14M08_03
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- Authors
- Puls, Miriam ; Sobisiak, Bettina; Bleckmann, Annalen ; Jacobshagen, Claudius ; Danner, Bernhard C. ; Huenlich, Mark ; Beißbarth, Tim ; Schoendube, Friedrich ; Hasenfuß, Gerd ; Seipelt, Ralf; Schillinger, Wolfgang
- Abstract
- Aims: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. Methods and results: Our study included 300 consecutive patients (mean age, 82 5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3%, p=0.04 for immediate procedural mortality; 17% vs. 5.8%, p=0.002 for 30-day mortality; and 23% vs. 6.4%, p<0.0001 for procedural mortality). The risk-score-based 30-day mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) reflected neither the observed 30-day mortality in both groups nor the threefold risk elevation in frail patients. In contrast, the Katz Index <6 was identified as a significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67 [95% CI: 1.7-4.3], p<0.0001). During follow-up (median observation period 537 days) 56% of frail vs. 24% of nonfrail patients died. Conclusions: Frailty status measured by the Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVIspecific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.
- Issue Date
- 2014
- Publisher
- Europa Edition
- Journal
- EuroIntervention
- ISSN
- 1774-024X
- eISSN
- 1969-6213