Prognostic value of the Erasmus Frailty Score on delirium after TAVI in older patients Jeannette Goudzwaard, MD Erasmus University Medical Center Rotterdam, The Netherlands J.goudzwaard@erasmusmc.nl
CONFLICT OF INTEREST DISCLOSURE I have no potential conflict of interest to report
Transcatheter Aortic Valve Implantion • Aortic valve Stenosis (AS) is highly prevalent in older population • When AS becomes symptomatic, 50 % of the patients dies within two years¹ • New standard for treatment of aortic valve stenosis (AS) for patients with high or intermediate surgical risk ² • Although minimally invasive, not without complications ¹Ross et al. 1968 ²Smith et al 2011; Baron et al, 2017
Post Operative Delirium • Incidence varies between 12-53%¹ • Associated with prolonged hospital stay, mortality, increased costs ² ¹Tse, Bowering et al. 2015, Eide, Ranhoff et al. 2015, Abawi et al. 2016 ² Inouye et al, 2014, Leslie et al, 2008
Risk prediction Mr E.U Mr. G.M.S Severe Aortic valve Stenosis Severe Aortic valve Stenosis 83 years 83 years Diabetes Mellitus Diabetes Mellitus Hypertension Hypertension
Risk stratification • STS score: Society of Thoracic Surgeons score • EuroScore Validated to predict surgical mortality Loss of accuracy and precision at higher spectrum operative risk Do not take in to account biological age Frailty could be used as novel biomarker Shroyer et al, 2003 Nashef et al, 1999
TAVI and Frailty Green et al., 2015 Assmann et al., 2016 Eide et al, 2015 Assman et al, 2016
Aim of the study Assess the value of a novel and self-developed frailty score Erasmus Frailty Score Can frailty predict post operative delirium in TAVI patients? Secondary outcomes Major vascular complications, infection, 30-day and 1 year mortality Statistics: logistic regression was used
TAVI Care & Cure program – November 2013 Outpatient Outpatient Geriatrics Multidisciplinary Valve team Cardiology Indication CGA Indication Suitability Appropriate therapy/ Risks / benefits Alternative Functionality ADL (Katz) IADL (Lawton – Brody) Erasmus Frailty Score Nourishment MNA-14 MUST Cognition MMSE Quality of Life EQ5D, EQ5D VAS, SF36
Erasmus Frailty Score
TAVI procedure • Procedure under general or local anesthesia, with local anesthesia as first choice • Transfemoral approach was access of first choice • After TAVI, patients were admitted tot ICU up to a minimum of 4 hours • Clinical involvement of geriatrician on the day of admission to 4 days post TAVI for assessing presence of delirium
Flowchart 213
Baseline characteristics
Functional characteristics
Delirium prediction Diagnosis delirium: 42 patiënts (20% )
Delirium prediction
Conclusion and Take Home Message • Delirium is a severe complication with high risk on negative outcomes • Erasmus Frailty Score predicts post operative delirium after TAVI • Erasmus Frailty Score can be added for risk stratification
Thanks to Dr. F. Mattace Raso Section of Geriatric Medicine, Dept. of Internal Medicine, Erasmus MC Prof. P. de Jaegere Dept. of Cardiology , Thoraxcenter Erasmus MC Mw. M. de Ronde-Tillmans Dept. of Cardiology , Thoraxcenter Erasmus MC Dhr. F. Acar Section of Geriatric Medicine, Dept. of Internal Medicine, Erasmus MC All members of the TAVI team j.goudzwaard@erasmusmc.nl
Future research targets • Effect of geriatric intervention on delirium and mortality • The impact of frailty on long term functionality after TAVI • Frailty and the impact on Quality of Life after TAVI • Procedural changes in blood pressure and the incidence of delirium
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