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Sigala E, Terentes-Printzios D, Gardikioti V, Baikoussis NG, Koumallos N, Katsaros A, Lozos V, Kouerinis I, Triantafillou K, Filis K, Tsioufis K, Vlachopoulos C. The Effect of Surgical Aortic Valve Replacement on Arterial Stiffness: Does the Valve Type Matter? J Pers Med 2024; 14:509. [PMID: 38793090 PMCID: PMC11122145 DOI: 10.3390/jpm14050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Despite the increasing use of transcatheter aortic valve procedures, many patients still require surgical aortic valve replacement (SAVR). Assessing arterial properties in patients undergoing SAVR for aortic valve stenosis can be challenging, and the existing evidence is inconclusive. Our study aimed to investigate the impact of SAVR on vascular stiffness and the quality of life, as well as the different effects of valve type on arterial properties. Methods: We included 60 patients (mean age 70.25 ± 8.76 years, 65% men) with severe symptomatic aortic stenosis who underwent SAVR. Arterial stiffness (cfPWV, baPWV) and vascular parameters (AIx@75, central pressures, SEVR) were measured at baseline, pre-discharge, and 1-year post-operation. The QOL was assessed using the generic questionnaire-short-form health survey 36 (SF-36) pre-operatively and at 1 year. Results: Post-SAVR, cfPWV increased immediately (7.67 ± 1.70 m/s vs. 8.27 ± 1.92 m/s, p = 0.009) and persisted at 1 year (8.27 ± 1.92 m/s vs. 9.29 ± 2.59 m/s, p ≤ 0.001). Similarly, baPWV (n = 55) increased acutely (1633 ± 429 cm/s vs. 2014 ± 606 cm/s, p < 0.001) and remained elevated at 1 year (1633 ± 429 cm/s vs. 1867 ± 408 cm/s, p < 0.001). Acute decrease in Alx@75 (31.16 ± 10% vs. 22.48 ± 13%, p < 0.001) reversed at 1 year (31.16 ± 10% vs. 30.98 ± 9%, p = 0.71). SEVR improved (136.1 ± 30.4% vs. 149.2 ± 32.7%, p = 0.01) and persisted at 1 year (136.1 ± 30.4% vs. 147.5 ± 30.4%, p = 0.01). SV had a greater cfPWV increase at 1 year (p = 0.049). The QOL improved irrespective of arterial stiffness changes. Conclusions: After SAVR, arterial stiffness demonstrates a persistent increase at 1-year, with valve type having a slight influence on the outcomes. These findings remain consistent despite the perceived QOL.
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Affiliation(s)
- Evangelia Sigala
- First Department of Cardiology, Hippokration Hospital, 11527 Athens, Greece
| | | | | | | | - Nikolaos Koumallos
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Andreas Katsaros
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Vasileios Lozos
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | - Ilias Kouerinis
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece (N.K.)
| | | | - Konstantinos Filis
- First Department of Surgery, Hippokration Hospital, 11527 Athens, Greece;
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Paek M, Rinderle T, Resnick R, Bekelman DB. Palliative Care Issues in Aortic Stenosis #467. J Palliat Med 2023; 26:1578-1580. [PMID: 37955887 DOI: 10.1089/jpm.2023.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
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Yousef S, Amabile A, Ram C, Singh S, Agarwal R, Milewski R, Assi R, Patel PA, Krane M, Geirsson A, Vallabhajosyula P. Direct relationship between transvalvular velocity and cardiac dysfunction, morbidity, and mortality in patients with aortic stenosis. J Card Surg 2022; 37:5052-5062. [PMID: 36378856 DOI: 10.1111/jocs.17199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Current guidelines recommend intervention in subjects with severe symptomatic aortic stenosis (AS), even though any degree of AS is associated with a higher risk of mortality. We investigated the association between the degree of AS, delineated by transvalvular flow velocity, and patient morbidity and mortality. METHODS Medically managed patients aged 40-95 years with maximum flow velocity (Vmax ) by echocardiography between 2013 and 2018 were stratified into five groups (A-E) based on the 75th, 90th, 97.5th, and the 99th percentiles of Vmax distribution. Patient characteristics, cardiac structural changes, and end-organ disease were compared using Kruskal-Wallis and Cochran-Armitage tests. Mortality over a median of 2.8 (1.52-4.8) years was compared using Kaplan-Meier curves and risk estimates were derived from the Cox model. RESULTS The Vmax was reported in 37,131 patients. There was a steady increase (from Group A towards E) in age, Caucasian race, structural cardiac changes, end-organ morbidities, and all-cause mortality. In reference to Group A, there as an increased risk of mortality in Groups B (hazard ratio [HR] = 1.3; confidence interval [CI]: 1.2-1.35; p < .0001), C (HR = 1.5; CI: 1.4-1.6; p < .0001), and D (HR = 1.8; CI: 1.6-2; p < .0001), with an exponential increase in Group E (HR = 2.5; CI: 2.2-2.8; p < .0001). CONCLUSIONS A direct, strong correlation exists between the degree of AS and cardiac structural changes and mortality. Patients with Vmax ≥ 97.5th percentile (≥3.2 m/s) might benefit from early intervention.
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Affiliation(s)
- Sameh Yousef
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrea Amabile
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chirag Ram
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Saket Singh
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ritu Agarwal
- Joint Data Analytics Team, Information Technology Service, Yale University, New Haven, Connecticut, USA
| | - Rita Milewski
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Roland Assi
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Prakash A Patel
- Division of Cardiac Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Markus Krane
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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One and Five-Year Mortality Risk Prediction in Patients with Moderate and Severe Aortic Stenosis. J Clin Med 2022; 11:jcm11102949. [PMID: 35629075 PMCID: PMC9146915 DOI: 10.3390/jcm11102949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Our goal was to develop a risk prediction model for mortality in patients with moderate and severe aortic stenosis (AS). (2) Methods: All patients aged 40−95 years, with echocardiographic evidence of moderate and severe AS at a single institution, were studied over a median of 2.8 (1.5−4.8) years, between 2013−2018. Patient characteristics and mortality were compared using Chi-squares, t-tests, and Kaplan−Meier (KM) curves, as appropriate. The risk calculation for mortality was derived using the Cox proportional hazards model. A risk score was calculated for each parameter, and the total sum of scores predicted the individualized risks of 1-and 5-year mortality. (3) Results: A total of 1991 patients with severe and 2212 with moderate AS were included. Severe AS patients were older, had a lower ejection fraction %, were more likely to be Caucasian, and had lower rates of obesity and smoking, but had higher rates of cardiac comorbidities and AVR (49.3% vs. 2.8%, p < 0.0001). The unadjusted overall mortality was 41.7% vs. 41%, p = 0.6530, and was not different using KM curves (log rank, p = 0.0853). The models included only patients with complete follow-up (3966 in the 1-year, and 816 in the 5-year model) and included 13 variables related to patient characteristics, degree of AS, and AVR. The C-statistic was 0.75 and 0.72 for the 1-year and the 5-year models, respectively. (4) Conclusions: Patients with moderate and severe AS experience high morbidity and mortality. The usage of a risk prediction model may provide guidance for clinical decision making in complex patients.
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Mirna M, Holnthoner M, Topf A, Jirak P, Fejzic D, Paar V, Kellermair J, Blessberger H, Reiter C, Kammler J, Motloch LJ, Jung C, Kretzschmar D, Franz M, Alushi B, Lauten A, Hoppe UC, Steinwender C, Lichtenauer M. Tumor necrosis factor alpha-an underestimated risk predictor in patients undergoing transcatheter aortic valve replacement (TAVR)? J Clin Lab Anal 2021; 35:e23977. [PMID: 34562276 PMCID: PMC8605157 DOI: 10.1002/jcla.23977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Systemic inflammation has been identified as a major cardiovascular risk factor in patients undergoing transcatheter aortic valve replacement (TAVR), yet currently, it is not adequately portrayed in scores for pre-interventional risk assessment. The aim of this study was to investigate the predictive ability of TNF-α in TAVR. METHODS A total of 431 patients undergoing transfemoral TAVR were enrolled in this study. Blood samples were drawn prior to intervention, 24 h post-intervention, 4, 5, and 7 days post-intervention, and 1, 3, and 6 months post-TAVR. RESULTS In a univariate Cox proportional hazard analysis, plasma concentrations of TNF-α after 24 h and after 5 days were associated with mortality after 12 months (after 24 h: HR 1.002 (1.000-1.004), p = 0.028; after 5d: HR 1.003 (1.001-1.005), p = 0.013). This association remained significant even after correction for confounders in a multivariate Cox regression analysis. Additionally, cut-offs were calculated. Patients above the cut-off for TNF-α after 5d had a significantly worse 12-month mortality than patients below the cut-off (18.8% vs. 2.8%, p = 0.046). CONCLUSION Plasma levels of TNF-α after 24 h and 5 days were independently associated with 12-month mortality in patients undergoing TAVR. Thus, TNF-α could represent a novel biomarker for enhanced risk stratification in these patients.
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Affiliation(s)
- Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Mario Holnthoner
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Peter Jirak
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Dzeneta Fejzic
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Jörg Kellermair
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Christian Reiter
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Jürgen Kammler
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Paracelsus Medical University of Salzburg, Linz, Austria
| | - Lukas J Motloch
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Dusseldorf, Germany
| | - Daniel Kretzschmar
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Marcus Franz
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Brunilda Alushi
- Department of General and Interventional Cardiology and Rhythmology, Helios Clinic, Erfurt, Germany
| | - Alexander Lauten
- Department of General and Interventional Cardiology and Rhythmology, Helios Clinic, Erfurt, Germany
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Paracelsus Medical University of Salzburg, Linz, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
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Abstract
The spread of Coronavirus Disease 2019 (COVID-19) pandemic across the globe and the United States presented unprecedented challenges with dawn of new policies to reserve resources and protect the public. One of the major policies adopted by hospitals across the nations were postponement of non-emergent procedures such as transaortic valve replacement (TAVR), left atrial appendage closure device (LAAC), MitraClip and CardioMEMS. Guidelines were based mainly on the avoidable clinical outcomes occurring during COVID-19 era. As our understanding of the SARS-CoV-2 evolved, advanced cardiac procedures may safely continue through careful advanced coordination. We aim to highlight the new guidelines published by different major cardiovascular societies, and discuss solutions to safely perform procedures to improve outcomes in a patient population with high acuity of illness during the COVID-19 pandemic era.
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Ocagli H, Lorenzoni G, Lanera C, Schiavo A, D’Angelo L, Liberti AD, Besola L, Cibin G, Martinato M, Azzolina D, D’Onofrio A, Tarantini G, Gerosa G, Cabianca E, Gregori D. Monitoring Patients Reported Outcomes after Valve Replacement Using Wearable Devices: Insights on Feasibility and Capability Study: Feasibility Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137171. [PMID: 34281108 PMCID: PMC8297062 DOI: 10.3390/ijerph18137171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/02/2023]
Abstract
Wearable devices (WDs) can objectively assess patient-reported outcomes (PROMs) in clinical trials. In this study, the feasibility and acceptability of using commercial WDs in elderly patients undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) will be explored. This is a prospective observational study. Participants were trained to use a WD and a smartphone to collect data on their physical activity, rest heart rate and number of hours of sleep. Validated questionnaires were also used to evaluate these outcomes. A technology acceptance questionnaire was used at the end of the follow up. In our participants an overall good compliance in wearing the device (75.1% vs. 79.8%, SAVR vs. TAVR) was assessed. Half of the patients were willing to continue using the device. Perceived ease of use is one of the domains that scored higher in the technology acceptance questionnaire. In this study we observed that the use of a WD is accepted in our frail population for an extended period. Even though commercial WDs are not tailored for clinical research, they can produce useful information on patient behavior, especially when coordinated with intervention tailored to the single patient.
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Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (H.O.); (G.L.); (C.L.); (M.M.); (D.A.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (H.O.); (G.L.); (C.L.); (M.M.); (D.A.)
| | - Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (H.O.); (G.L.); (C.L.); (M.M.); (D.A.)
| | - Alessandro Schiavo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35121 Padua, Italy; (A.S.); (L.D.); (A.D.L.); (G.T.)
| | - Livio D’Angelo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35121 Padua, Italy; (A.S.); (L.D.); (A.D.L.); (G.T.)
| | - Alessandro Di Liberti
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35121 Padua, Italy; (A.S.); (L.D.); (A.D.L.); (G.T.)
| | - Laura Besola
- Saint Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6 VBC, Canada;
| | - Giorgia Cibin
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (G.C.); (A.D.); (G.G.)
| | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (H.O.); (G.L.); (C.L.); (M.M.); (D.A.)
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (H.O.); (G.L.); (C.L.); (M.M.); (D.A.)
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
| | - Augusto D’Onofrio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (G.C.); (A.D.); (G.G.)
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35121 Padua, Italy; (A.S.); (L.D.); (A.D.L.); (G.T.)
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (G.C.); (A.D.); (G.G.)
| | - Ester Cabianca
- Cardiology Unit, Dipartimento Strutturale Cardio-vascolare, Azienda ULSS 8 Berica, 36100 Vicenza, Italy;
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (H.O.); (G.L.); (C.L.); (M.M.); (D.A.)
- Correspondence: ; Tel.: +39-049-8275384
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Frantzen AT, Eide LSP, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, Lauck S, Ranhoff AH, Rudolph JL, Skaar E, Norekvål TM. Frailty Status and Patient-Reported Outcomes in Octogenarians Following Transcatheter or Surgical Aortic Valve Replacement. Heart Lung Circ 2021; 30:1221-1231. [PMID: 33714672 DOI: 10.1016/j.hlc.2020.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/23/2020] [Accepted: 10/22/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Frailty status and patient-reported outcomes are especially pertinent in octogenarians following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) to guide treatment decisions and promote patient-centred care. AIM We aimed to determine if frailty changed 6 months after aortic valve replacement (AVR) in octogenarians, and to describe changes in self-rated health according to frailty status in patients who underwent TAVI or SAVR. METHOD In a prospective cohort study, frailty and self-rated health were measured one day prior to and 6 months after AVR. Frailty status was measured with the Study of Osteoporotic Fracture index. Self-rated health was measured comprehensively with the disease-specific Minnesota Living with Heart Failure Questionnaire, the generic Medical Outcomes Study Short Form-12 questionnaire (SF-12), and two global questions from The World Health Organization Quality of Life Instrument Abbreviated. RESULTS Data were available for 143 consecutive patients (mean age 83±2.7 years, 57% women; 45% underwent TAVI). At baseline, 34% were robust, 27% prefrail, and 39% frail. Overall, there was no change in the distribution of frailty status 6 months after baseline (p=0.13). However, on an individual level 65 patients changed frailty status after AVR (40 patients improved and 25 declined). Improvement in frailty status was common in prefrail (33%; n=13) and frail patients (48%; n=27). Patients had improved self-rated health after AVR, with significant differences between frailty states both at baseline (SF-12 physical: 37.4 [robust], 33.1 [prefrail], 31.6 [frail], p=0.03); SF-12 mental: 51.9 [robust], 50.8 [prefrail], 44.5 [frail], p<0.001); and at the 6-month follow-up (SF-12 physical: 45.4 [robust], 38.3 [prefrail], 32.1 [frail], p<0.001); SF-12 mental: 54.9 [robust], 49.6 [prefrail], 46.8 [frail], p=0.002). CONCLUSIONS Advanced treatment performed in a high-risk population allowed people to improve their self-rated health. Although frailty is associated with poor self-rated health, frailty status does not equal negative outcomes. The frail patients were those who improved most in self-rated physical and mental health. They had the lowest baseline self-rated health scores and had therefore the most to gain.
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Affiliation(s)
| | - Leslie S P Eide
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Karel K J Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, Canada; School of Nursing, University of British Columbia, Vancouver, Canada
| | - Anette H Ranhoff
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - James L Rudolph
- Center for Gerontology, Brown School of Public Health, Brown University, Providence, USA
| | - Elisabeth Skaar
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
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Stocco F, Fabozzo A, Bagozzi L, Cavalli C, Tarzia V, D'Onofrio A, Lorenzoni G, Chiminazzo V, Gregori D, Gerosa G. Biological versus mechanical aortic valve replacement in non-elderly patients: a single-centre analysis of clinical outcomes and quality of life. Interact Cardiovasc Thorac Surg 2020; 32:515-521. [PMID: 33313767 DOI: 10.1093/icvts/ivaa306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/16/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate short- and long-term clinical outcomes, including the perceived health-related quality of life, in patients younger than 65 years having undergone aortic valve replacement either with biological or mechanical valve prostheses. METHODS Between 2002 and 2013, 242 consecutive patients <65 years of age underwent isolated aortic valve replacement at our institution, either with biological (n = 134, 55.4%) or mechanical (n = 108, 44.6%) prostheses. Survival, health-related quality of life, short- and long-term clinical outcomes and echocardiographic data were analysed with a retrospective, single-centre study. Propensity matching was performed. RESULTS No significant difference in survival was found between the 2 groups (mechanical versus biological: 100% vs 96.6% at 1 year, 98.2% vs 93.1% at 5 years and 92.3% vs 83.4% at 10 years after surgery, P = 0.091). For all the interviewed patients (n = 161, 66.5%), perceived quality of life at the latest follow-up was excellent. Need for reoperation was higher in the bioprosthetic group (8% vs 0%, P = 0.995), whereas the rate of major bleedings was higher in the mechanical valve group (3% vs 20%, P = 0.094). The mean and maximum transvalvular pressure gradients were 20.5 ± 9.7 and 37.4 ± 17.5 mmHg in the biological group and 14.8 ± 4.8 and 26.6 ± 9.2 mmHg in the mechanical group (P = 0.014). CONCLUSIONS No significant differences were found between biological and mechanical valves in terms of patients' survival, clinical outcomes and quality of life. Mean and maximum transvalvular pressure gradients were significantly higher in the biological group. The majority of patients would opt for the same prosthesis type, if asked to choose again.
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Affiliation(s)
- Fabio Stocco
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Assunta Fabozzo
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenzo Bagozzi
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Chiara Cavalli
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Vincenzo Tarzia
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Augusto D'Onofrio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Valentina Chiminazzo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Cardiogenic Shock in Aortic Stenosis: Is It the Time for "Primary" TAVR? JACC Cardiovasc Interv 2020; 13:1326-1328. [PMID: 32499023 DOI: 10.1016/j.jcin.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/23/2022]
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Changes in cognitive functions and quality of life in patients after transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:82-88. [PMID: 32368240 PMCID: PMC7189141 DOI: 10.5114/aic.2020.93915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic option for patients with severe aortic stenosis (AS). However, an association between cognitive functions (CF) and health-related quality of life (HRQoL) in TAVI patients is still unclear. Aim To assess the long-term changes in CF and HRQoL in elderly patients with AS after TAVI. Material and methods A total of 259 patients who underwent cardiological and psychological TAVI qualification were enrolled and divided into the normal (n = 174) and impaired cognition group (n = 85). CF and HRQoL characteristics assessed at baseline and 13 months were compared between groups. The analysis of multiple linear regression was performed to identify the association between HRQoL and CF and to assess the influence of TAVI on HRQoL. Results There was no difference in CF between baseline and follow-up. However, an improvement in attention functions and memory skills in the cognitively impaired group was noted at follow-up. In addition, HRQoL scores increased in both groups. An independent predictor associated with HRQoL was global CF (β = –213, p = 0.01), which explained 7% of CF variation. Improvements in all five dimensions of HRQoL, from 4.8% in self-care and up to 33.6% in pain/discomfort, were found. At follow-up, 60% of TAVI patients had improved health, 12% had worse health, 4% showed no change and 24% had a “mixed” change. Conclusions TAVI is associated with positive changes in the functioning of elderly patients at long-term follow-up.
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Gavalaki A, Roussakis A, Zoubourlis P, Contrafouris C, Zarkalis D, Perreas K. Outcomes and quality of life after aortic valve surgery in octogenarians. J Card Surg 2019; 35:341-344. [PMID: 31782827 DOI: 10.1111/jocs.14377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The emergence of catheter-based techniques questioned existing treatment strategies for patients with aortic stenosis. The increasing effectiveness of transcatheter aortic valve implantation therapies justifies a renewed evaluation of the results in terms of survival rate as well as the quality of life (QoL) after surgical aortic valve replacement (SAVR) in the elderly. The aim of this study is the assessment of QoL in octogenarians undergoing isolated SAVR. METHODS A retrospective observational and descriptive study between January 2015 and January 2018, was conducted. Eighty-four Caucasians patients over 80 years of age undergoing aortic valve replacement in a single unit were, finally, followed-up. The patients' medical records were reviewed and QoL after a median 22-month follow-up time was evaluated by administering the EQ-5D questionnaire on the telephone. RESULTS Mean European System for Cardiac Operative Risk Evaluation II was 2.1%. The 30-day mortality was 0% and the 1-year mortality was 3.6%. On the assessment of QoL within mean follow-up time of 22 months, performed in 81 patients (survivors), a remarkable improvement was recorded in 76.5% of patients (62 patients), while 12.3% (10 patients) reported aggravation of their health status and 11.1% (9 patients) had no change. CONCLUSIONS Mortality rates after SAVR can be kept at very low levels, especially in experienced high-volume centers, even in the elderly. Furthermore, it must be pointed out that the majority of these patients achieve a good functional status and a satisfactory QoL after the operation. Therefore, SAVR should not be withheld on the grounds of age alone.
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Affiliation(s)
- Aikaterini Gavalaki
- First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Antonios Roussakis
- First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Panagiotis Zoubourlis
- First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Dimitrios Zarkalis
- First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Konstantinos Perreas
- First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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13
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Health-related quality of life following transcatheter aortic valve implantation using transaortic, transfemoral approaches and surgical aortic valve replacement-a single-center study. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:657-665. [PMID: 30534139 PMCID: PMC6283815 DOI: 10.11909/j.issn.1671-5411.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To evaluate short- and long-term changes in quality of life (QoL) in patients undergoing transcatheter aortic valve implantation (TAVI) and to assess differences in patient QoL when using the TAVI transaortic (TAVI TAo) approach compared with the transfemoral approach (TAVI TF) and surgical aortic valve replacement (SAVR). Methods Ninety-seven patients were assessed. Thirty-two patients underwent TAVI TAo, 31 underwent TAVI TF and 34 patients underwent SAVR. QoL was assessed using the EQ-5D-3L questionnaire at baseline, after one month and one year. Results Mean patient age was 80 years (range, 61–92 years) and the mean logistic EuroSCORE was 12.45% (range, 1.39%–78.98%). Declared health state at baseline was significantly lower in TAVI TF (P < 0.001) and after one month there were no differences between the three groups (P = 0.99). After one year, SAVR patient results of the EQ-5D-3L index value were lower in comparison to both TAVI patient groups (P < 0.05). The analysis also showed significant differences between the results of EQ-5D-3L index value over the one month and one year follow-up (TAVI TAo, P < 0.001; TAVI TF, P < 0.05; SAVR, P < 0.05). In all groups, the values significantly increased after one-month and one-year of follow-up in comparison to baseline value. Significant differences were also demonstrated between Visual Analogue Scale values (VAS). Conclusions A significant improvement in QoL was observed in all three patient groups. Regardless of the TAVI approach, EQ-5D-3L and VAS values were significantly increased after one-month and one-year follow up; the SAVR patients however, reported lower health status when compared to the TAVI patients.
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Bhardwaj A, Ramanan T, Sawant AC, Sinibaldi E, Pham M, Khan S, Qureshi R, Agrawal N, Khalil C, Hansen R, Baldo S, Colern G, Corbelli J, Pershad A, Beck H, Iyer V. Quality of life outcomes in transcatheter aortic valve replacement patients requiring pacemaker implantation. J Arrhythm 2018; 34:441-449. [PMID: 30167016 PMCID: PMC6111478 DOI: 10.1002/joa3.12065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/31/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Permanent pacemaker implantation is the most common complication after Transcatheter aortic valve replacement (TAVR) and is associated with worse outcomes and mortality. However, its impact on quality-of-life (QoL) outcomes remains unknown. METHODS We included 383 consecutive patients undergoing TAVR from January 2012 to 2016 who completed a baseline Kansas City Cardiomyopathy Questionnaire (KCCQ-12) health survey. The clinical, laboratory, angiographic, QoL, mortality, and occurrence of poor outcomes (KCCQ-12 score < 45 or KCCQ decrease of ≥10 points) were obtained. RESULTS The mean age was 83 ± 8 years, 51% were men, and majority were Caucasians (n = 364, 95%). Permanent pacemaker (PPM) was implanted in 11.5% of patients post-TAVR. PPM patients were more likely to have prior conduction disease including RBBB (25% vs 12%, P = .02) and PQ interval >250 ms (11% vs 5%, P = .07). One-month median KCCQ-12 scores were significantly lower among PPM patients (84.7 vs 68.8, P = .04), but did not differ significantly at 1-year (86.5 vs 90.6, P = .5) post-TAVR. Occurrence of poor outcomes did not differ significantly among those with or without PPM at 1 month (11% vs 7%, P = .39) and 1 year (13% vs 9%, P = .45), respectively. However, patients with poor QoL outcomes at 1 month post-TAVR also had significantly worse mortality during follow-up in unadjusted (31.3% vs 4.5%, P < .001) and adjusted (HR = 5.30, 95% [CI: 1.85-15.22, P = .002])analyses, respectively. CONCLUSION Permanent pacemaker implantation is associated with short-term reduction in QoL without long-term implications post-TAVR. Patients with poor QoL post-TAVR also have significantly higher mortality.
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Affiliation(s)
- Aishwarya Bhardwaj
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Tharmathai Ramanan
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Abhishek C. Sawant
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Everett Sinibaldi
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Michael Pham
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Sahoor Khan
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Reema Qureshi
- Department of MedicineDivision of CardiologyWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Nikhil Agrawal
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Charl Khalil
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Rosemary Hansen
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Shannon Baldo
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Gerald Colern
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - John Corbelli
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Ashish Pershad
- Department of MedicineDivision of Interventional CardiologyBanner University Medical CenterPhoenixAZUSA
| | - Hiroko Beck
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
| | - Vijay Iyer
- Department of MedicineDivision of CardiologyState University of New York at BuffaloBuffaloNYUSA
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15
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Olsson K, Näslund U, Nilsson J, Hörnsten Å. Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study. Nurs Open 2018; 5:149-157. [PMID: 29599990 PMCID: PMC5867280 DOI: 10.1002/nop2.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022] Open
Abstract
Aim The aim of this study was to explore how patients experienced the recovery process from transcatheter aortic valve implantation. Design A qualitative approach where in-depth interviews were used. Method Eleven men and eight women undergoing transcatheter aortic valve implantation were individually interviewed 6 months after transcatheter aortic valve implantation. Grounded theory was used for the analysis. Results The analysis generated the core concept "A journey of balancing between life-struggle and hope" connected to descriptive, bipolar categories. Before transcatheter aortic valve implantation patients not only felt threatened but also experienced hope. The rehabilitation phase was described as demanding or surprisingly simple. At the 6 months follow-up patients were pleased to return to life, however, still struggling with limitations. To feel hope is essential for transcatheter aortic valve implantation patients' well-being, both before and during the recovery process. It is important that healthcare professionals not only support hopeful thinking but also take time to discuss and prepare patients, talk about concerns and build confidence. Individual plans for rehabilitation should be designed.
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Affiliation(s)
- Karin Olsson
- Cardiology, Heart CentreDepartment of Public Health and Clinical MedicineUmeå UniversityUmeaSweden
- Department of NursingUmeå UniversityUmeaSweden
| | - Ulf Näslund
- Cardiology, Heart CentreDepartment of Public Health and Clinical MedicineUmeå UniversityUmeaSweden
| | - Johan Nilsson
- Cardiology, Heart CentreDepartment of Public Health and Clinical MedicineUmeå UniversityUmeaSweden
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Steiner JM, Cooper S, Kirkpatrick JN. Palliative care in end-stage valvular heart disease. Heart 2017; 103:1233-1237. [PMID: 28747535 DOI: 10.1136/heartjnl-2016-310538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023] Open
Abstract
Valvular heart disease (VHD), particularly aortic valve disease, is prevalent with increasing incidence. When surgery is not possible, or when risks outweigh benefits, percutaneous treatment options may offer effective alternatives. However, procedures may not always go as planned, and frail patients or those whose symptoms are caused by other comorbidities may not benefit from valve intervention at all. Significant effort should be made to assess frailty, comorbidities and patient goals prior to intervention. Palliative care (PC) should play a critical role in the care of patients with severe valve disease. PC is specialised medical care that aims to optimise health-related quality of life by managing symptoms and clarifying patient values and goals of care. It should be implemented at the time of diagnosis and continue throughout the disease course. Because of the paucity of studies dedicated to the provision of PC to patients with advanced VHD, further research is needed.
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Affiliation(s)
- Jill M Steiner
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Stephanie Cooper
- Division of Cardiology, University of Washington, Seattle, Washington, USA.,Division of Cardiology, Harborview Medical Center, Seattle, Washington, USA
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17
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Auensen A, Hussain AI, Bendz B, Aaberge L, Falk RS, Walle-Hansen MM, Bye J, Andreassen J, Beitnes JO, Rein KA, Pettersen KI, Gullestad L. Morbidity outcomes after surgical aortic valve replacement. Open Heart 2017; 4:e000588. [PMID: 28674629 PMCID: PMC5471875 DOI: 10.1136/openhrt-2017-000588] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/16/2022] Open
Abstract
Objective In patients with mild to moderate operative risk, surgical aortic valve replacement (SAVR) is still the preferred treatment for patients with severe symptomatic aortic stenosis (AS). Aiming to broaden the knowledge of postsurgical outcomes, this study reports a broad set of morbidity outcomes following surgical intervention. Methods Our cohort comprised 442 patients referred for severe AS; 351 had undergone SAVR, with the remainder (91) not operated on. All patients were evaluated using the 6-minute walk test (6MWT), were assigned a New York Heart Association class (NYHA) and Canadian Cardiovascular Society class (CCS), with additional scores for health-related quality of life (HRQoL), cognitive function (Mini-Mental State Examination (MMSE)) and myocardial remodelling (at inclusion and at 1-year follow-up). Adverse events and mortality were recorded. Results Three-year survival after SAVR was 90.0%. SAVR was associated with an improved NYHA class, CCS score and HRQoL, and provoked reverse ventricular remodelling. The 6MWT decreased, while the risks of major adverse cardiovascular events (death, non-fatal stroke/transient ischaemic attack or myocardial infarction) and all-cause hospitalisation (incidence rate per 100 patient-years) were 13.5 and 62.4, respectively. The proportion of cognitive disability measured by MMSE increased after SAVR from 3.2% to 8.8% (p=0.005). Proportion of patients living independently at home, having attained NYHA class I, was met by 49.1% at 1 year. Unoperated individuals had a poor prognosis in terms of any outcome. Conclusion This study provides knowledge of outcomes beyond what is known about the mortality benefit after SAVR to provide insight into the morbidity burden of modern-day SAVR.
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Affiliation(s)
- Andreas Auensen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Bjørn Bendz
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | | | - Jorun Bye
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johanna Andreassen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jan Otto Beitnes
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kjell Ingar Pettersen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
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18
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Bashir M, Harky A, Bleetman D, Adams B, Roberts N, Balmforth D, Yap J, Lall K, Shipolini A, Oo A, Uppal R. Aortic Valve Replacement: Are We Spoiled for Choice? Semin Thorac Cardiovasc Surg 2017; 29:265-272. [DOI: 10.1053/j.semtcvs.2017.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 12/27/2022]
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19
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Lange R, Beckmann A, Neumann T, Krane M, Deutsch MA, Landwehr S, Kötting J, Welz A, Zahn R, Cremer J, Figulla HR, Schuler G, Holzhey DM, Funkat AK, Heusch G, Sack S, Pasic M, Meinertz T, Walther T, Kuck KH, Beyersdorf F, Böhm M, Möllmann H, Hamm CW, Mohr FW. Quality of Life After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:2541-2554. [DOI: 10.1016/j.jcin.2016.09.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
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20
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Incorporating Shared Decision Making into Perioperative Care of Older Adults. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0148-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Kaier K, Gutmann A, Baumbach H, von Zur Mühlen C, Hehn P, Vach W, Beyersdorf F, Zehender M, Bode C, Reinöhl J. Quality of life among elderly patients undergoing transcatheter or surgical aortic valve replacement- a model-based longitudinal data analysis. Health Qual Life Outcomes 2016; 14:109. [PMID: 27456092 PMCID: PMC4960709 DOI: 10.1186/s12955-016-0512-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 07/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Quality of life (QoL) measurements reported in observational studies are often biased, since patients who failed to improve are more likely to be unable to respond due to death or impairment. In order to observe the development of QoL in patients close to death, we analyzed a set of monthly QoL measurements for a cohort of elderly patients treated for aortic valve stenosis (AS) with special consideration of the effect of distance to death. Methods QoL in 169 elderly patients (age ≥ 75 years), treated either with transcatheter aortic valve replacement (TAVR; n = 92), surgical aortic-valve replacement (n = 70), or drug-based therapy (n = 7), was evaluated using the standardized EQ-5D questionnaire. Over a two-year period, patients were consulted using monthly telephone interviews or outpatient visits, leading to a total of 2463 time points at which QoL values, New York Heart Association (NYHA) Functional Classification and their status of assistance were assessed. Furthermore, post-procedural clinical events and complications were monitored. Linear and ordered logistic regression analyses with random intercept were carried out, taking into account overall trends and distance to death. Results QoL measures decreased slightly over time, were temporarily impaired at month 1 after the initial episode of hospitalization and decreased substantially at the end of life with a measurable effect starting at the sixth from last follow-up (month) before death. Many clinical complications (bleeding complications, stroke, acute kidney injury) showed an impairment of QoL measurements, but the inclusion of lagged variables demonstrated medium term (three months) QoL impairments for access site bleeding only. All other complications are associated with event-related impairments that decreased dramatically at the second and third follow-up interviews (month) after event. Conclusions Distance to death shows clear effects on QoL and should be taken into account when analyzing QoL measures in the elderly patients treated for aortic valve stenosis. Trial registration German Clinical Trial Register Nr. DRKS00000797
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, D-79104, Freiburg, Germany. .,Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany.
| | - Anja Gutmann
- Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | | | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, D-79104, Freiburg, Germany
| | - Werner Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, D-79104, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany
| | - Jochen Reinöhl
- Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany
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Olsson K, Nilsson J, Hörnsten Å, Näslund U. Patients' self-reported function, symptoms and health-related quality of life before and 6 months after transcatheter aortic valve implantation and surgical aortic valve replacement. Eur J Cardiovasc Nurs 2016; 16:213-221. [PMID: 27169460 DOI: 10.1177/1474515116650342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Aortic stenosis is the most common valve disease in western countries and has poor prognosis without treatment. Surgical aortic valve replacement (SAVR) is the gold standard, and transcatheter aortic valve implantation (TAVI) is a new method that is used in high-risk patients who are denied surgery. The purpose of treatment is not only to save life, but also to reduce symptoms and increase health-related quality of life (HRQoL). OBJECTIVE The aim of this study was to describe patients' self-reported outcomes in terms of physical function, symptoms, dependence, HRQoL, and cognitive function after TAVI and SAVR. METHODS All patients treated with TAVI during 1 year ( n = 24) and age-matched patients treated with SAVR ( n = 24) were included. Data were collected on the day before and at 6 months after treatment using structural questionnaires. RESULTS Self-rated function was low before treatment and increased at follow-up. A quarter of all patients reported syncope at baseline, and none reported this at follow-up. Breathlessness was reported by all patients to be the most limiting cardiac symptom, but the TAVI patients reported more severe symptoms. At 6 months' follow-up, symptoms were reduced, but breathlessness and fatigue were still common, especially in the TAVI group. HRQoL, which was very low in the TAVI group at baseline, increased in all dimensions except social function. CONCLUSION We found no change in cognitive function or dependence at follow-up. There was no difference in the size of improvement between groups. The results could be helpful when informing future patients in order to give them realistic expectations.
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Affiliation(s)
- Karin Olsson
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,2 Department of Nursing, Umeå University, Umeå, Sweden
| | - Johan Nilsson
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Åsa Hörnsten
- 2 Department of Nursing, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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23
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Olsen SJ, Fridlund B, Eide LS, Hufthammer KO, Kuiper KK, Nordrehaug JE, Skaar E, Norekvål TM. Changes in self-reported health and quality of life in octogenarian patients one month after transcatheter aortic valve implantation. Eur J Cardiovasc Nurs 2016; 16:79-87. [PMID: 27036955 DOI: 10.1177/1474515116641297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In addition to favourable results regarding mortality and morbidity it is important to identify the impact transcatheter aortic valve implantation (TAVI) has on patients' quality of life. AIMS The aims were: (i) to describe clinical characteristics, self-reported health and quality of life in octogenarians before TAVI intervention; (ii) to determine changes in self-reported health and quality of life one month after TAVI; and (iii) to establish the clinical importance of the findings. METHODS A prospective cohort study was conducted on consecutively enrolled octogenarians with severe aortic stenosis undergoing TAVI ( N = 65). Self-reported health and quality of life were recorded at baseline and one month later using two global questions from the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF), the generic Short Form Health 12 and the disease-specific Minnesota Living with Heart Failure Questionnaire. RESULTS One month after TAVI, WHOQOL-BREF showed that self-reported health improved moderately ( p < 0.001), while quality of life improved slightly, but not statistically significantly ( p = 0.06). There were changes in all Short Form Health 12 domains, except social functioning and role emotional. The estimated changes were 3.6 to 5.8 with large confidence intervals. The Physical Component Summary increased statistically significantly from baseline to 30 days (30.6-34.7; p = 0.02), but the Mental Component Summary did not (46.9-50.0; p = 0.13). CONCLUSION Despite being an advanced treatment performed in a high risk population, TAVI in octogenarians improves short-term self-reported global health and generic physical health and quality of life. These patient-reported outcomes have importance, particularly in this age group.
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Affiliation(s)
- Siv Js Olsen
- 1 Division of Internal Medicine, University Hospital of North Norway, Harstad, Norway
- 2 Department of Health and Care Sciences, The Arctic University of Norway, Harstad, Norway
| | - Bengt Fridlund
- 3 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- 4 School for Health and Welfare, Jönköping University, Sweden
- 5 Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway
| | - Leslie Sp Eide
- 6 Department of Clinical Science, University of Bergen, Norway
| | - Karl O Hufthammer
- 7 Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Karel Kj Kuiper
- 3 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jan E Nordrehaug
- 6 Department of Clinical Science, University of Bergen, Norway
- 8 Department of Cardiology, Stavanger University Hospital, Norway
| | - Elisabeth Skaar
- 3 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- 9 Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone M Norekvål
- 3 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- 5 Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway
- 6 Department of Clinical Science, University of Bergen, Norway
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Jansen Klomp WW, Nierich AP, Peelen LM, Brandon Bravo Bruinsma GJ, Dambrink JHE, Moons KGM, van’t Hof AWJ. Survival and quality of life after surgical aortic valve replacement in octogenarians. J Cardiothorac Surg 2016; 11:38. [PMID: 26992390 PMCID: PMC4799630 DOI: 10.1186/s13019-016-0432-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with symptomatic severe aortic stenosis, advanced age is often a reason for a transcatheter rather than surgical aortic valve replacement. In this pre-transcatheter cohort we had the unique opportunity to study outcomes after surgical aortic valve replacement for severe aortic stenosis in patients who might currently be triaged to a percutaneous approach. METHODS In a prospective single-center cohort study we compared the incidence of peri-operative complications, mortality, and health-related quality of life in octogenarians versus patients aged <80 years. The quality of life was measured using the SF-36 questionnaire and expressed as a physical and mental component score (PCS and MCS respectively); a score of 50 equals the average score in the age-matched general population. The association between age and the component scores at one-year follow-up was studied with the use of linear regression, corrected for a set of confounding variables. RESULTS We included 762 patients, of whom 21.4 % was aged >80 and 49.0 % underwent concomitant revascularization. In octogenarians, the incidence of post-operative delirium was 11.0 %, which was higher than in patients aged below 80 (6.2 %, p = 0.034); the operative mortality (1.9 % vs. 2.9 %; p = 0.59) and long-term survival were not different however (log-rank p = 0.75). In octogenarians, the quality of life was impaired 30-days after surgery (PCS 45.01, p < 0.001; MCS 48.21, p = 0.04), which improved towards or above normal values at one-year follow-up (PCS: 49.92, p = 0.67, MCS: 52.55, p < 0.001). After correction for confounding, age was not significantly associated with the one-year PCS (β 0.08 per year, p = 0.34) or MCS (β 0.08 per year, p = 0.32). CONCLUSIONS This pre-transcatheter study showed that surgical aortic valve replacement in octogenarians could be performed with very low mortality, and with a relevant and significant increase of the quality of life towards normal values. Also, age was not associated with a lower PCS or MCS one-year after surgery.
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Affiliation(s)
- Wouter W. Jansen Klomp
- />Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB Zwolle, The Netherlands
- />Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, 3584CG The Netherlands
| | - Arno P. Nierich
- />Anaesthesiology and Intensive care, Isala Clinics, Dokter van Heesweg 2, 8025AB Zwolle, The Netherlands
| | - Linda M. Peelen
- />Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, 3584CG The Netherlands
| | | | - Jan-Henk E. Dambrink
- />Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB Zwolle, The Netherlands
| | - Karel G. M. Moons
- />Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, 3584CG The Netherlands
| | - Arnoud W. J. van’t Hof
- />Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB Zwolle, The Netherlands
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Brecker S, Mealing S, Padhiar A, Eaton J, Sculpher M, Busca R, Bosmans J, Gerckens UJ, Wenaweser P, Tamburino C, Bleiziffer S, Piazza N, Moat N, Linke A. Cost-utility of transcatheter aortic valve implantation for inoperable patients with severe aortic stenosis treated by medical management: a UK cost-utility analysis based on patient-level data from the ADVANCE study. Open Heart 2014; 1:e000155. [PMID: 25349700 PMCID: PMC4207938 DOI: 10.1136/openhrt-2014-000155] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To use patient-level data from the ADVANCE study to evaluate the cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared to medical management (MM) in patients with severe aortic stenosis from the perspective of the UK NHS. METHODS A published decision-analytic model was adapted to include information on TAVI from the ADVANCE study. Patient-level data informed the choice as well as the form of mathematical functions that were used to model all-cause mortality, health-related quality of life and hospitalisations. TAVI-related resource use protocols were based on the ADVANCE study. MM was modelled on publicly available information from the PARTNER-B study. The outcome measures were incremental cost-effectiveness ratios (ICERs) estimated at a range of time horizons with benefits expressed as quality-adjusted life-years (QALY). Extensive sensitivity/subgroup analyses were undertaken to explore the impact of uncertainty in key clinical areas. RESULTS Using a 5-year time horizon, the ICER for the comparison of all ADVANCE to all PARTNER-B patients was £13 943 per QALY gained. For the subset of ADVANCE patients classified as high risk (Logistic EuroSCORE >20%) the ICER was £17 718 per QALY gained). The ICER was below £30 000 per QALY gained in all sensitivity analyses relating to choice of MM data source and alternative modelling approaches for key parameters. When the time horizon was extended to 10 years, all ICERs generated in all analyses were below £20 000 per QALY gained. CONCLUSION TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis.
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Affiliation(s)
| | | | | | | | | | - Rachele Busca
- Medtronic International Trading Sàrl , Tolochenaz , Switzerland
| | | | | | | | | | | | - Nicolo Piazza
- McGill University Health Center, Royal Victoria Hospital , Montreal , Canada
| | - Neil Moat
- Royal Brompton Hospital , London , UK
| | - Axel Linke
- University Hospital Leipzig , Leipzig , Germany
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Denvir MA, Highet G, Robertson S, Cudmore S, Reid J, Ness A, Hogg K, Weir C, Murray S, Boyd K. Future Care Planning for patients approaching end-of-life with advanced heart disease: an interview study with patients, carers and healthcare professionals exploring the content, rationale and design of a randomised clinical trial. BMJ Open 2014; 4:e005021. [PMID: 25023130 PMCID: PMC4120336 DOI: 10.1136/bmjopen-2014-005021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the optimal content and design of a clinical trial of an end-of-life intervention for advanced heart disease with patients, carers and healthcare professionals. DESIGN Qualitative interview and focus group study. SETTING Community and hospital-based focus groups and interviews. PARTICIPANTS Stable community-dwelling patients, informal carers (PC, n=15) and primary and secondary care based healthcare professionals (HCP, n=11). RESULTS PC highlighted fragmentation of services and difficulty in accessing specialist care as key barriers to good care. They felt that time for discussion with HCP was inadequate within current National Health Service (NHS) healthcare systems. HCP highlighted uncertainty of prognosis, explaining mortality risk to patients and switching from curative to palliative approaches as key challenges. Patient selection, nature of the intervention and relevance of trial outcomes were identified by HCP as key challenges in the design of a clinical trial. CONCLUSIONS PC and HCP expressed a number of concerns relevant to the nature and content of an end-of-life intervention for patients with advanced heart disease. The findings of this study are being used to support a phase II randomised clinical trial of Future Care Planning in advanced heart disease.
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Affiliation(s)
- Martin A Denvir
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gill Highet
- Department of Palliative Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shirley Robertson
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sarah Cudmore
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Janet Reid
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrea Ness
- Department of cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Karen Hogg
- Cardiology Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Christopher Weir
- Edinburgh Health Services Research Unit, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Scott Murray
- Primary Palliative Care Research Group, Community Health Sciences—General Practice, University of Edinburgh, Edinburgh, UK
| | - Kirsty Boyd
- Department of Palliative Care, Royal Infirmary of Edinburgh, Edinburgh, UK
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27
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Mehta N, Chokshi NP, Kirkpatrick JN. Cardiac imaging in the geriatric population: what do we think we know, and what do we need to learn? Prog Cardiovasc Dis 2014; 57:204-14. [PMID: 25216620 DOI: 10.1016/j.pcad.2014.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiac imaging plays an important role in coronary artery disease (CAD), congestive heart failure (HF) and valvular heart disease (VHD) in the elderly. Imaging defines the structure and function of the cardiac system, refining the understanding of patients' anatomy and physiology and informing a host of clinical care decisions, including prognosis. Yet there is a paucity of evidence to guide the rational use of many imaging modalities in patients of advanced age, a population with considerable clinical heterogeneity, high prevalence and burden of cardiovascular disease (CVD) and atypical presentations of CVD. This paper discusses important considerations for cardiac imaging for older adults, particularly in regard to CAD, VHD and HF, and then presents domains for future research to produce data that would inform clinical care guidelines, appropriate use criteria and imaging lab protocols to address the unique needs of the fast-growing elderly population.
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Affiliation(s)
- Nidhi Mehta
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Neel P Chokshi
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - James N Kirkpatrick
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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