The Impact of Frailty on Patient-Centered Outcomes Following Aortic Valve Replacement

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Abstract

<div class="section"> <a class="named-anchor" id="d9056351e274">  </a> <h5 class="section-title" id="d9056351e275">Background:</h5> <p id="d9056351e277">Frailty confers risk for surgical morbidity and mortality. Whether patient-reported measures of health, well-being, or quality of life respond differently to surgery in non-frail and frail individuals is unknown. </p> </div><div class="section"> <a class="named-anchor" id="d9056351e279">  </a> <h5 class="section-title" id="d9056351e280">Methods:</h5> <p id="d9056351e282">Older adults with severe aortic stenosis presenting for surgery were assessed for frailty using Cardiovascular Health Study Criteria. Patient-reported measures of functional capacity (Duke Activity Status Index [DASI]), physical and mental health (Medical Outcomes Study Short Form-Physical and Mental Component Scales [SF-12 PCS and SF-12 MCS, respectively]), well-being (linear analogue self-assessment [LASA]), and quality of life (LASA) were administered before and 3 months after surgery. </p> </div><div class="section"> <a class="named-anchor" id="d9056351e284">  </a> <h5 class="section-title" id="d9056351e285">Results:</h5> <p id="d9056351e287">Of 103 participants (mean age of 80.6 years), 54 were frail. Frail participants had lower baseline DASI, SF-12 PCS, SF-12 MCS, physical well-being, and quality of life scores than non-frail participants. At follow-up, frail participants showed significant improvement in physical function, with DASI and SF-12 PCS scores improving by 50% and 14%, respectively. Non-frail subjects did not significantly improve in these measures. SF-12 MCS scores also improved to a greater extent in frail compared to non-frail participants (3.6 vs < 1 point). Furthermore, the frail participants improved to a greater extent than non-frail participants in physical well-being (21.6 vs 7.1 points) and quality of life measures (25.1 vs 8.7 points). </p> </div><div class="section"> <a class="named-anchor" id="d9056351e289">  </a> <h5 class="section-title" id="d9056351e290">Conclusions:</h5> <p id="d9056351e292">Frailty is prevalent in older adults with severe aortic stenosis and is associated with poor physical and mental function, physical well-being, and quality of life. In response to surgery, frail participants exhibited greater improvement in these patient-centered outcomes than non-frail peers. </p> </div>

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Quantification of GDF11 and Myostatin in Human Aging and Cardiovascular Disease.

Marissa Schafer, Elizabeth Atkinson, Patrick Vanderboom … (2016)

Growth and differentiation factor 11 (GDF11) is a transforming growth factor β superfamily member with a controversial role in aging processes. We have developed a highly specific LC-MS/MS assay to quantify GDF11, resolved from its homolog, myostatin (MSTN), based on unique amino acid sequence features. Here, we demonstrate that MSTN, but not GDF11, declines in healthy men throughout aging. Neither GDF11 nor MSTN levels differ as a function of age in healthy women. In an independent cohort of older adults with severe aortic stenosis, we show that individuals with higher GDF11 were more likely to be frail and have diabetes or prior cardiac conditions. Following valve replacement surgery, higher GDF11 at surgical baseline was associated with rehospitalization and multiple adverse events. Cumulatively, our results show that GDF11 levels do not decline throughout aging but are associated with comorbidity, frailty, and greater operative risk in older adults with cardiovascular disease.

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Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis.

Ryan G. Webb, Anthony Smith, Vasilis Babaliaros … (2011)

Background- Transcatheter aortic valve replacement (TAVR) has been shown to improve survival compared with standard therapy in patients with severe aortic stenosis who cannot have surgery. The effects of TAVR on health-related quality of life have not been reported from a controlled study. Methods and Results- The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgical valve replacement to TAVR (n=179) or standard therapy (n=179). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 12-item Short Form-12 General Health Survey (SF-12). The primary end point was the KCCQ overall summary score (range, 0-100; higher=better). At baseline, mean KCCQ summary scores (35±20) and SF-12 physical summary scores (28±7) were markedly depressed. Although the KCCQ summary score improved from baseline in both groups, the extent of improvement was greater after TAVR compared with control at 1 month (mean between-group difference, 13 points; 95% confidence interval, 8-19; P<0.001) with larger benefits at 6 months (mean difference, 21 points; 95% confidence interval, 15-27; P<0.001) and 12 months (mean difference, 26 points; 95% confidence interval, 19-33; P<0.001). At 12 months, TAVR patients also reported higher SF-12 physical and mental health scores with mean differences compared with standard care of 5.7 and 6.4 points, respectively (P<0.001 for both comparisons). Conclusions- Among inoperable patients with severe aortic stenosis, compared with standard care, TAVR resulted in significant improvements in health-related quality of life that were maintained for at least 1 year. Clinical Trials Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.

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Use of a single-item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice.

Zeeshan Butt, Lynne Wagner, Jennifer L. Beaumont … (2008)

Fatigue, pain, distress, and anorexia are four commonly encountered symptoms in cancer. To evaluate the usefulness of a single-item screening for these symptoms, 597 ambulatory outpatients with solid tumors were administered a self-report screening instrument within the first 12 weeks of chemotherapy. Patients rated the severity of each symptom on a 0-10 scale, at its worst over the past three days, with higher ratings associated with higher symptom levels. From this sample, 148 patients also completed a more comprehensive assessment of these symptoms. Two criteria were used to determine optimal cut-off scores on the screening items: 1) the sensitivity and specificity of each screening item to predict clinical cases using receiver-operating characteristics analysis and 2) the proportion of patients at each screening score who reported that some relief of the target symptom would significantly improve their life. Optimal cut-off scores ranged from 4 to 6 depending on the target symptom (area under the curve range=0.68-0.88). Use of single-item screening instruments for fatigue, pain, distress, and anorexia may assist routine clinical assessment in ambulatory oncology practice. In turn, such assessments may improve identification of those at risk of morbidity and decreased quality of life due to excess symptom burden.

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Author and article information

Journal

Title: The Journals of Gerontology: Series A

Publisher: Oxford University Press (OUP)

ISSN (Print): 1079-5006

ISSN (Electronic): 1758-535X

Publication date Created: July 2017

Publication date: July 2017

Publication date (Print): July 01 2017

Publication date (Electronic): March 10 2017

Volume: 72

Issue: 7

Pages: 917-921

Affiliations

[1 ] Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, Minnesota.

[2 ] Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota.

[3 ] Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.

[4 ] Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.

[5 ] Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

[6 ] Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.

Article

DOI: 10.1093/gerona/glx038

PMC ID: 5458410

PubMed ID: 28329140

SO-VID: 1e2452e7-9d2c-4c3e-be14-1a8fb424d707

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The Impact of Frailty on Patient-Centered Outcomes Following Aortic Valve Replacement

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Most cited references 11

Quantification of GDF11 and Myostatin in Human Aging and Cardiovascular Disease.

Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis.

Use of a single-item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice.

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