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

Abstract

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

Acknowledgments

This study has been funded by the Sunnybrook AFP Innovation fund [SHS-15-008]. N. Herrmann and KL Lanctôt were the principal investigators on the study.

Ethics

This study was conducted in accordance with the Declaration of Helsinki and implemented with approval and oversight from the Research Ethics Board of Sunnybrook Health Sciences Centre. All participants provided written, informed consent.

Author Contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

SE Fremes is supported by grant funding from Medtronic Inc. (Physio-Control Intl. Corp.), Bayer Pharmaceuticals, Bayer Inc. Germany, and HLT Inc., USA. HC Wijeysundera is supported by grant funding from Medtronic Inc and Edwards Life Sciences Inc, outside the submitted work. KL Lanctôt reports grants from the National Institute of Aging (5R01AG052510-02), Alzheimer’s Association (PTC-18-543823), Canadian Institutes of Health Research (FRN#308227), personal fees from AbbVie, Axovant Sciences Ltd, and Otsuka, outside the submitted work. The authors report no other conflicts of interest in this work.