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Exploring changes in functional status while waiting for transcatheter aortic valve implantation Forman, Jacqueline Marie


As the body ages, there is a natural decline in physical and cognitive abilities. The presence of chronic disease can accelerate this process. Aortic stenosis (AS) is a structural heart disease primarily associated with aging. Untreated patients die within 2 to 5 years following the onset of symptoms. For individuals with multiple co-morbidities, surgical treatment is not an option because of high risk for surgical complications. An innovative and minimally invasive procedure called transcatheter aortic valve implantation (TAVI) has emerged as a safe and viable treatment option for higher risk patients. Because of the rapid disease progression of severe AS and the varying wait-times prior to procedure, it is important to understand changes in functional status while waiting for TAVI. The purpose of this study was to examine the changes in functional status between time of eligibility assessment and TAVI procedure date. Changes in functional status including 5-Metre Gait Speed, Canadian Study of Health and Aging Clinical Frailty Scale and Mini Mental State Examination were evaluated using an exploratory prospective cohort design. Thirty two patients participated in the study with median age 81 (range 64 to 93). Functional status declined between time of assessment and time of TAVI: Gait speed increased by 0.53 seconds (p = 0.01) and Clinical Frailty Scale increased by 0.31 (from 4.3 to 4.6, p = 0.01). Patients who waited longer than six weeks for TAVI (n = 19) had a larger decline in gait speed than patients who waited less than six weeks (n = 10) (0.8 sec vs 0.0 sec, p = 0.04). Patients who were living alone (n =11) had a larger increase in frailty scores compared to patients living with another adult (n = 21) (0.6 vs 0.1, p = 0.05). This study has shown that change in functional status may be an important assessment to monitor while patients are waiting for TAVI. Results may be used to facilitate individualized care and management strategies and inform health care policy to develop evidence based benchmarks for safe wait-times. Future research with larger samples could validate the exploratory findings of this study.

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