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Aortic and vascular disease
Original research article
Frailty is associated with delirium and mortality after transcatheter aortic valve implantation
  1. Patricia Assmann1,2,
  2. Peter Kievit3,
  3. Kees van der Wulp3,
  4. Michel Verkroost4,
  5. Luc Noyez4,
  6. Hans Bor1 and
  7. Yvonne Schoon5
  1. 1Department of Primary and Elderly Care, Radboud University Medical Centre Nijmegen, The Netherlands
  2. 2ZZG Care Group, Nijmegen, The Netherlands
  3. 3Department of Cardiology, Radboud University Medical Centre Nijmegen, The Netherlands
  4. 4Department of Cardio-Thoracic Surgery, Radboud University Medical Centre Nijmegen, The Netherlands
  5. 5Department of Geriatrics, Radboud University Medical Centre Nijmegen, The Netherlands
  1. Correspondence to Dr Patricia Assmann; p.assmann{at}zzgzorggroep.nl

Abstract

Objective We hypothesised that frailty assessment is of additional value to predict delirium and mortality after transcatheter aortic valve implantation (TAVI).

Methods Observational study in 89 consecutive patients who underwent TAVI. Inclusion from November 2012 to February 2014, follow-up until April 2014. Measurement of the association of variables from frailty assessment and cardiological assessment with delirium and mortality after TAVI, respectively.

Results Incidence of delirium after TAVI: 25/89 (28%). Variables from frailty assessment protectively associated with delirium were: Mini Mental State Examination, (OR 0.79; 95% CI 0.65 to 0.96; p=0.02), Instrumental Activities of Daily Living (OR 0.79; 95% CI 0.63 to 0.99; p=0.04) and gait speed (OR 0.05; 95% CI 0.01 to 0.50; p=0.01). Timed Up and Go was predictively associated with delirium (OR 1.14; 95% CI 1.03 to 1.26; p=0.01). From cardiological assessment, pulmonary hypertension was protectively associated with delirium (OR 0.34; 95% CI 0.12 to 0.98; p=0.05). Multivariate logistic analysis: Nagelkerke R2=0.359, Mini Mental State Examination was independently associated with delirium. Incidence of mortality: 11/89 (12%). Variables predictively associated with mortality were: the summary score Frailty Index (HR 1.66, 95% CI 1.06 to 2.60; p=0.03), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (HR 1.14, 95% CI 1.06 to 1.22; p<0.001) and complications (HR 4.81, 95% CI 1.03 to 22.38; p=0.05). Multivariate Cox proportional hazards analysis: Nagelkerke R2=0.271, Frailty Index and EuroSCORE II were independently associated with mortality.

Conclusions Delirium frequently occurs after TAVI. Variables from frailty assessment are associated with delirium and mortality, independent of cardiological assessment. Thus, frailty assessment may have additional value in the prediction of delirium and mortality after TAVI.

  • frailty assessment
  • delirium
  • mortality
  • TAVI

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000478

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    Footnotes

    • Contributors PA made substantial contribution to the study concept and design; acquisition, analysis and interpretation of data; drafting of the article; revising repeatedly; and gave final approval of the version to be published. PK and YS made substantial contribution to the study concept and design; acquisition, analysis and interpretation of data; revising of the article critically for important intellectual content; and gave final approval of the version to be published. KvdW, MV and LNmade substantial contribution to acquisition of data; revising of the article critically for important intellectual content; and gave final approval of the version to be published. HBmade substantial contribution to analysis and interpretation of data; revising of the article critically for important intellectual content; and gave final approval of the version to be published.All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement No additional data are available.