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The value of screening for cognition, depression, and frailty in patients referred for TAVI

Authors Khan MM, Lanctôt KL, Fremes SE, Wijeysundera HC, Radhakrishnan S, Gallagher D, Gandell D, Brenkel MC, Hazan EL, Docteur NG, Herrmann N

Received 17 January 2019

Accepted for publication 19 March 2019

Published 8 May 2019 Volume 2019:14 Pages 841—848


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker

Maisha M Khan,1,2 Krista L Lanctôt,1–3 Stephen E Fremes,4 Harindra C Wijeysundera,4 Sam Radhakrishnan,4 Damien Gallagher,3 Dov Gandell,5 Megan C Brenkel,1 Elias L Hazan,1 Natalia G Docteur,1 Nathan Herrmann1,3

1Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; 2Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; 3Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada; 4Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 5Department of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Background: Current surgical risk assessment tools fall short of appreciating geriatric risk factors including cognitive deficits, depressive, and frailty symptoms that may worsen outcomes post-transcatheter aortic valve implantation (TAVI). This study hypothesized that a screening tool, SMARTIE, would improve detection of these risks pre-TAVI, and thus be predictive of postoperative delirium (POD) and 30-day mortality post-TAVI.
Design: Prospective observational cohort study, using a historical cohort for comparison.
Participants: A total of 234 patients (age: 82.2±6.7 years, 59.4% male) were included. Half were screened using SMARTIE.
Methods: The SMARTIE cohort was assessed for cognitive deficits and depressive symptoms using the Mini-Cog test and PHQ-2, respectively. Measures of frailty included activities of daily living inventory, the Timed Up and Go test and grip strength. For the pre-SMARTIE cohort, we extracted cognitive deficits, depression and frailty symptoms from clinic charts. The incidence of POD and 30-day mortality were recorded. Bivariate chi-square analysis or t-tests were used to report associations between SMARTIE and pre-SMARTIE groups. Multivariable logistic regression models were employed to identify independent predictors of POD and 30-day mortality.
Results: More patients were identified with cognitive deficits (χ2=11.73, p=0.001), depressive symptoms (χ2=8.15, p=0.004), and physical frailty (χ2=5.73, p=0.017) using SMARTIE. Cognitive deficits were an independent predictor of POD (OR: 8.4, p<0.01) and 30-day mortality (OR: 4.04, p=0.03).
Conclusion: This study emphasized the value of screening for geriatric risk factors prior to TAVI by demonstrating that screening increased identification of at-risk patients. It also confirmed findings that cognitive deficits are predictive of POD and mortality following TAVI.

Keywords: TAVI, cognition, depression, frailty

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