The value of screening for cognition, depression, and frailty in patients referred for TAVI
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 Herrmann1,31Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program...
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Dove Medical Press
2019
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oai:doaj.org-article:29bfc6485ae64a5ea3d40fe0767ce5d32021-12-02T03:08:55ZThe value of screening for cognition, depression, and frailty in patients referred for TAVI1178-1998https://doaj.org/article/29bfc6485ae64a5ea3d40fe0767ce5d32019-05-01T00:00:00Zhttps://www.dovepress.com/the-value-of-screening-for-cognition-depression-and-frailty-in-patient-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Maisha 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 Herrmann1,31Neuropsychopharmacology 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, CanadaBackground: 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, frailtyKhan MMLanctôt KLFremes SEWijeysundera HCRadhakrishnan SGallagher DGandell DBrenkel MCHazan ELDocteur NGHerrmann NDove Medical PressarticleTAVIcognitiondepressionfrailtyGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 841-848 (2019) |
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EN |
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TAVI cognition depression frailty Geriatrics RC952-954.6 |
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TAVI cognition depression frailty Geriatrics RC952-954.6 Khan MM Lanctôt KL Fremes SE Wijeysundera HC Radhakrishnan S Gallagher D Gandell D Brenkel MC Hazan EL Docteur NG Herrmann N The value of screening for cognition, depression, and frailty in patients referred for TAVI |
| description |
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 Herrmann1,31Neuropsychopharmacology 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, CanadaBackground: 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 |
| format |
article |
| author |
Khan MM Lanctôt KL Fremes SE Wijeysundera HC Radhakrishnan S Gallagher D Gandell D Brenkel MC Hazan EL Docteur NG Herrmann N |
| author_facet |
Khan MM Lanctôt KL Fremes SE Wijeysundera HC Radhakrishnan S Gallagher D Gandell D Brenkel MC Hazan EL Docteur NG Herrmann N |
| author_sort |
Khan MM |
| title |
The value of screening for cognition, depression, and frailty in patients referred for TAVI |
| title_short |
The value of screening for cognition, depression, and frailty in patients referred for TAVI |
| title_full |
The value of screening for cognition, depression, and frailty in patients referred for TAVI |
| title_fullStr |
The value of screening for cognition, depression, and frailty in patients referred for TAVI |
| title_full_unstemmed |
The value of screening for cognition, depression, and frailty in patients referred for TAVI |
| title_sort |
value of screening for cognition, depression, and frailty in patients referred for tavi |
| publisher |
Dove Medical Press |
| publishDate |
2019 |
| url |
https://doaj.org/article/29bfc6485ae64a5ea3d40fe0767ce5d3 |
| work_keys_str_mv |
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