Section of Geriatrics, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Cardiol. 2019 Feb 1;276:48-52. doi: 10.1016/j.ijcard.2018.10.093. Epub 2018 Oct 28.
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.
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.
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].
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.
在接受经导管主动脉瓣植入术（TAVI）的患者中，虚弱与 1 年死亡率增加相关，但虚弱与短期结局的关系结果存在冲突。本研究调查了一种新的和自我开发的伊拉斯谟虚弱评分与 TAVI 后短期和长期结局的关系。
TAVI Care & Cure 是一项正在进行的观察性研究，纳入了在伊拉斯谟大学医学中心接受 TAVI 的连续患者。在 TAVI 之前，评估虚弱状态。伊拉斯谟虚弱评分（EFS）定义如下：1 分：简易精神状态检查（MMSE）<27 分，必须≥2 分，握力女性<20kg，男性<30kg，KATZ 指数≥1 活动受限，Lawton 和 Brody 指数≥2 活动受限。最高得分为 5 分。当评分≥3 分时，患者被归类为虚弱。通过老年病学家在 TAVI 前后进行的日常临床评估来评估谵妄的存在。死亡率数据从荷兰民事登记处获得。评估虚弱对短期和长期结局的影响。
213 例患者纳入分析。28.6%（n=61）存在虚弱（EFS≥3）。基线虚弱与患者发生谵妄有关[比值比（OR）3.3（95%置信区间[CI] 1,55-7,10），p=0.002]，与 1 年死亡率增加相关[风险比（HR）2.1（95%CI 1.01-4.52），p=0.047]。
伊拉斯谟虚弱评分与老年患者 TAVI 后谵妄和 1 年死亡率相关，可以作为传统危险因素的补充。
