Ramos Tuarez Fergie J, Pino Jesus E, Alrifai Abdulah, Kabach Mohamad, Donath Elie, Saona Jorge, Chavez Julio Grajeda, Diaz Ximena Torres, Jimenez Marcelo, Chait Robert
University of Miami-JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida.
Catheter Cardiovasc Interv. 2019 May 1;93(6):1138-1145. doi: 10.1002/ccd.28020. Epub 2018 Dec 12.
To assess the impact of WATCHMAN™ on quality of life (QoL) in octogenarians and nonagenarians.
QoL after WATCHMAN™ device in the elderly remains unknown.
This is a prospective and retrospective cohort study of patients that underwent WATCHMAN™ implantation in a tertiary cardiovascular center from April 1, 2015 to September 27, 2017. The primary outcome was a prospective assessment of QoL via the SF-12v2 Health Survey (SF-12v2) in those aged ≥80 and ≥90 years. Secondary outcomes include major bleeding, stroke, vascular complications, pericardial effusion, device related thrombus (DRT), prolonged length of stay (LOS), acute kidney injury (AKI), and recurrent hospitalizations.
This cohort of 151 patients included 48/151 (32%) females with a mean age of 80 ± 7.7 years. Mean CHA DS -VASc was 4.38 ± 1.36 and mean HAS-BLED was 3.27 ± 1.17. Octogenarians 65/81(80%) and nonagenarians 16/81(20%) comprised 81/151(54%) of patients (mean age 86 ± 4.3 years) from which 36/65 (55%) octogenarians and 10/16 (63%) nonagenarians completed SF-12v2 evaluation at 22 ± 10 and 30 ± 10-months. Octogenarians demonstrated enhanced physical component scores (PCS), and nonagenarians equal PCS versus the age-adjusted norm (45.43 ± 9.84 versus 38.68 ± 11.04, P = 0.0003, and 41.26 ± 12.36 versus 38.68 ± 11.04, P = 0.6463, respectively). The mental component scores (MCS) of octogenarians and nonagenarians remained comparable (51.80 ± 9.56 and 48.97 ± 9.92 versus 50.06 ± 10.94, respectively, P = 0.4659). No stroke, vascular complications, pericardial effusions, or readmissions related to WATCHMAN™ occurred. No difference among patients <80, ≥80, and ≥90 years was found in major bleeding events, DRT, prolonged LOS, or AKI (P = 0.0569, 0.116, 0.498, and 0.795, respectively).
Octogenarians and nonagenarians experience favorable long-term QoL after WATCHMAN™, with acceptable bleeding risk and low incidence of procedure-related complications.
评估WATCHMAN™对八旬及九旬老人生活质量（QoL）的影响。
老年患者植入WATCHMAN™装置后的生活质量仍不清楚。
这是一项对2015年4月1日至2017年9月27日在一家三级心血管中心接受WATCHMAN™植入术患者的前瞻性和回顾性队列研究。主要结局是通过SF-12v2健康调查（SF-12v2）对年龄≥80岁和≥90岁的患者进行生活质量的前瞻性评估。次要结局包括大出血、中风、血管并发症、心包积液、装置相关血栓（DRT）、住院时间延长（LOS）、急性肾损伤（AKI）和再次住院。
该队列共151例患者，其中48/151（32%）为女性，平均年龄80±7.7岁。平均CHA₂DS-VASc为4.38±1.36，平均HAS-BLED为3.27±1.17。八旬老人65/81（80%）和九旬老人16/81（20%）占患者总数的81/151（54%）（平均年龄86±4.3岁），其中36/65（55%）的八旬老人和10/16（63%）的九旬老人在22±10个月和30±10个月时完成了SF-12v2评估。八旬老人的身体成分得分（PCS）有所提高，九旬老人的PCS与年龄调整后的正常值相当（分别为45.43±9.84对38.68±11.04，P = 0.0003；41.26±12.36对38.68±11.04，P = 0.6463）。八旬老人和九旬老人的精神成分得分（MCS）保持相当（分别为51.80±9.56和48.97±9.92对50.06±10.94，P = 0.4659）。未发生与WATCHMAN™相关的中风、血管并发症、心包积液或再次入院。在大出血事件、DRT、住院时间延长或AKI方面，年龄＜80岁、≥80岁和≥90岁的患者之间未发现差异（P分别为0.0569、0.116、0.498和0.795）。
八旬及九旬老人在植入WATCHMAN™后有良好的长期生活质量，出血风险可接受，与手术相关的并发症发生率低。
