Prognostic value of the Erasmus Frailty Score on delirium after TAVI - - PowerPoint PPT Presentation

Prognostic value of the Erasmus Frailty Score

• n 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

• 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

Transcatheter Aortic Valve Implantion

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 Cardiology Indication Suitability Risks / benefits Outpatient Geriatrics CGA Multidisciplinary Valve team Indication Appropriate therapy/ 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