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Research Article| Volume 276, P48-52, February 01, 2019

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The Erasmus Frailty Score is associated with delirium and 1-year mortality after Transcatheter Aortic Valve Implantation in older patients. The TAVI Care & Cure program

  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Jeannette A. Goudzwaard
    Correspondence
    Corresponding author at: 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Section of Geriatrics, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Marjo J.A.G. de Ronde-Tillmans
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Nahid El Faquir
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Ferhat Acar
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Section of Geriatrics, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Nicolas M. Van Mieghem
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Mattie J. Lenzen
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Peter P.T. de Jaegere
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Francesco U.S. Mattace-Raso
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Section of Geriatrics, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Published:October 27, 2018DOI:https://doi.org/10.1016/j.ijcard.2018.10.093

      Highlights

      • The Erasmus Frailty score is associated with postoperative delirium and 1 year mortality.
      • The Erasmus Frailty score is associated with short and long term outcomes after TAVI.
      • Risk stratification can be improved by adding a frailty status to known clinical risk factors.

      Abstract

      Background

      Frailty in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) has been associated with an increased 1-year mortality rate but the relation of frailty and short term outcomes yields conflicting results. This study investigated the association of a novel and self-developed Erasmus Frailty Score with both short and long term outcomes after TAVI.

      Methods

      TAVI Care & Cure is an observational ongoing study, which includes consecutive patients undergoing TAVI at the Erasmus University Medical Centre. Prior to the TAVI, frailty status was assessed. The Erasmus Frailty Score (EFS) was defined as follows: 1 point assigned if: MMSE was <27 points, MUST ≥2 points, grip strength <20 kg for females, <30 kg for males, KATZ index ≥1 limited activity, Lawton and Brody index ≥2 limited activity. The maximum score was 5. Patients were classified as frail when the score was ≥3. Presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and post-TAVI. Mortality data were obtained from the Dutch Civil Registry. The impact of frailty on short and long term outcomes was evaluated.

      Results

      213 patients were included for analysis. Frailty was present in 28.6% (n = 61), (EFS ≥ 3). Baseline frailty was associated with patients developing a delirium [OR 3.3 (95% CI 1,55–7,10), p = 0.002] and with increased risk of 1-year mortality [HR 2.1 (95% CI 1.01–4.52), p = 0.047].

      Conclusion

      The Erasmus Frailty Score is associated with delirium and 1 year mortality in older patients after TAVI and can be used as a complement to traditional risk factors.

      Keywords

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