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Comprehensive Geriatric Assessment and Exercise Capacity in Cardiac Rehabilitation for Patients Referred to Transcatheter Aortic Valve Implantation

      Comprehensive geriatric assessment (CGA)-based cardiac rehabilitation (CR) program is essential for patients before and after transcatheter aortic valve implantation (TAVI). This study aimed to explore the values of CGA and exercise capacity in CR for patients referred to TAVI. A retrospective analysis was conducted in 90 patients referred to TAVI from January to October 2019. CR strategies started before TAVI. The association between clinical characteristics, CGA, and change in six-minute walk distance (Δ6MWD) was analyzed with multivariate regression models. Most of patients had cognitive impairment (50%), malnutrition (61%), and frailty (83%). After the CR, the proportion of cognitive impairment, malnutrition, and frail patients was significantly decreased by 21%, 40%, and 57%, respectively (p = 0.002, p <0.001, p <0.001). The 6MWD at a month after discharge (291.9 ± 98.8 m) was significantly improved than that at discharge after TAVI (218.8 ± 114.3m, p <0.001). The multivariate regression analysis indicated body mass index (BMI; Δ6MWD:12.0, 95% confidence interval [CI] 0.3 to 23.8, p = 0.045), frailty (Δ6MWD: −57.9, 95% CI −81.8 to −34.1, p <0.001) and malnutrition (Δ6MWD: −25.1, 95% CI −47.0 to −3.2, p = 0.026) as the associated predictors of Δ6MWD. In conclusion, functional status in patients referred to TAVI could be improved by CGA-based CR. BMI, frailty, and malnutrition were associated with the efficacy of CR on exercise capacity. CGA can play the important role in the evaluation and making strategies for CR in patients.
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      References

        • Nkomo VT
        • Gardin JM
        • Skelton TN
        • Gottdiener JS
        • Scott CG
        • Enriquez-Sarano M.
        Burden of valvular heart diseases: a population-based study.
        Lancet. 2006; 368: 1005-1011
        • Altisent OAJ
        • Puri R
        • Regueiro A
        • Chamandi C
        • Rodriguez-Gabella T
        • Del Trigo M
        • Campelo-Parada F
        • Couture T
        • Marsal JR
        • Côté M
        • Paradis JM
        • DeLarochellière R
        • Doyle D
        • Mohammadi S
        • Dumont E
        • Rodés-Cabau J
        Predictors and association with clinical outcomes of the changes in exercise capacity after transcatheter aortic valve replacement.
        Circulation. 2017; 136: 632-643
        • Kim CA
        • Rasania SP
        • Afilalo J
        • Popma JJ
        • Lipsitz LA
        • Kim DH.
        Functional status and quality of life after transcatheter aortic valve replacement: a systematic review.
        Ann Intern Med. 2014; 160: 243-254
        • Huded CP
        • Huded JM
        • Sweis RN
        • Ricciardi MJ
        • Malaisrie SC
        • Davidson CJ
        • Flaherty JD.
        The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement.
        Catheter Cardiovasc Interv. 2017; 89: 1286-1291
        • Pressler A
        • Christle JW
        • Lechner B
        • Grabs V
        • Haller B
        • Hettich I
        • Jochheim D
        • Mehilli J
        • Lange R
        • Bleiziffer S
        • Halle M.
        Exercise training improves exercise capacity and quality of life after transcatheter aortic valve implantation: a randomized pilot trial.
        Am Heart J. 2016; 182: 44-53
        • Pressler A
        • Förschner L
        • Hummel J
        • Haller B
        • Christle JW
        • Halle M.
        Long-term effect of exercise training in patients after transcatheter aortic valve implantation: follow-up of the SPORT: TAVI randomised pilot study.
        Eur J Prev Cardiol. 2018; 25: 794-801
        • Tarro Genta F
        • Tidu M
        • Bouslenko Z
        • Bertolin F
        • Salvetti I
        • Comazzi F
        • Giannuzzi P
        Cardiac rehabilitation after transcatheter aortic valve implantation compared to patients after valve replacement.
        J Cardiovasc Med (Hagerstown). 2017; 18: 114-120
        • Dhesi J
        • Moonesinghe SR
        • Partridge J.
        Comprehensive geriatric assessment in the perioperative setting; where next?.
        Age Ageing. 2019; 48: 624-627
        • Sainsbury A
        • Seebass G
        • Bansal A
        • Young JB.
        Reliability of the Barthel index when used with older people.
        Age Ageing. 2005; 34: 228-232
        • Folstein MF
        • Folstein SE
        • McHugh PR.
        ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Guigoz Y.
        The mini nutritional assessment (MNA) review of the literature—what does it tell us?.
        J Nutr Health Aging. 2006; 10: 466-467
        • Smarr KL
        • Keefer AL
        Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Suppression Scale (CES-D), geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), and patient health questionnaire.
        Arthritis Care Res (Hoboken). 2011; 63: S454-S466
        • Fried LP
        • Tangen CM
        • Walston J
        • Newman AB
        • Hirsch C
        • Gottdiener J
        • Seeman T
        • Tracy R
        • Kop WJ
        • Burke G
        • McBurnie MA.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Anon
        ATS statement: guidelines for the six-minute walk test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Baumgartner H
        • Falk V
        • Bax JJ
        • De Bonis M
        • Hamm C
        • Holm PJ
        • Iung B
        • Lancellotti P
        • Lansac E
        • Rodriguez Muñoz D
        • Rosenhek R
        • Sjögren J
        • Tornos Mas P
        • Vahanian A
        • Walther T
        • Wendler O
        • Windecker S
        • Zamorano JL.
        2017 ESC/EACTS guidelines for the management of valvular heart disease.
        Eur Heart J. 2017; 38: 2739-2791
        • Okoh AK
        • Chauhan D
        • Kang N
        • Haik N
        • Merlo A
        • Cohen M
        • Haik B
        • Chen C
        • Russo MJ.
        The impact of frailty status on clinical and functional outcomes after transcatheter aortic valve replacement in nonagenarians with severe aortic stenosis.
        Catheter Cardiovasc Interv. 2017; 90: 1000-1006
        • González Ferreiro R
        • Muñoz-García AJ
        • López Otero D
        • Avanzas P
        • Pascual I
        • Alonso-Briales JH
        • González-Juanatey JR
        • Pun F
        • Jiménez-Navarro MF
        • Hernández-García JM
        • Morís C
        • Trillo Nouche R.
        Nutritional risk index predicts survival in patients undergoing transcatheter aortic valve replacement.
        Int J Cardiol. 2019; 276: 66-71
        • Stortecky S
        • Schoenenberger AW
        • Moser A
        • Kalesan B
        • Jüni P
        • Carrel T
        • Bischoff S
        • Schoenenberger C-M
        • Stuck AE
        • Windecker S
        • Wenaweser P.
        Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation.
        JACC Cardiovasc Interv. 2012; 5: 489-496
        • Ungar A
        • Mannarino G
        • der Velde N van
        • Baan J
        • Thibodeau M-P
        • Masson J-B
        • Santoro G
        • van Mourik M
        • Jansen S
        • Deutsch C
        • Bramlage P
        • Kurucova J
        • Thoenes M
        • Maggi S
        • Schoenenberger AW
        Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation—results from the CGA-TAVI multicentre registry.
        BMC Cardiovasc Disord. 2018; 18: 1
        • Partridge JSL
        • Harari D
        • Martin FC
        • Dhesi JK.
        The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review.
        Anaesthesia. 2014; 69: 8-16
        • Fauchère I
        • Weber D
        • Maier W
        • Altwegg L
        • Lüscher TF
        • Grünenfelder J
        • Nowak A
        • Tüller D
        • Genoni M
        • Falk V
        • Hermann M.
        Rehabilitation after TAVI compared to surgical aortic valve replacement.
        Int J Cardiol. 2014; 173: 564-566
        • Leon MB
        • Smith Smith
        • Mack M
        • Miller DC
        • Moses JW
        • Svensson LG
        • Tuzcu EM
        • Webb JG
        • Fontana GP
        • Makkar RR
        • Brown DL
        • Block PC
        • Guyton RA
        • Pichard AD
        • Bavaria JE
        • Herrmann HC
        • Douglas PS
        • Petersen JL
        • Akin JJ
        • Anderson WN
        • Wang D
        • Pocock S
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Rosenberg A
        • Ngandu T
        • Rusanen M
        • Antikainen R
        • Bäckman L
        • Havulinna S
        • Hänninen T
        • Laatikainen T
        • Lehtisalo J
        • Levälahti E
        • Lindström J
        • Paajanen T
        • Peltonen M
        • Soininen H
        • Stigsdotter-Neely A
        • Strandberg T
        • Tuomilehto J
        • Solomon A
        • Kivipelto M.
        Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: the FINGER trial.
        Alzheimer's Dement. 2018; 14: 263-270
        • Völler H
        • Salzwedel A
        • Nitardy A
        • Buhlert H
        • Treszl A
        • Wegscheider K.
        Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation.
        Eur J Prev Cardiol. 2015; 22: 568-574
        • Bagur R
        • Rodés-Cabau J
        • Dumont E
        • Larochellière R
        • De Doyle D
        • Bertrand OF
        • Côté M
        • Poirier P
        • Pibarot P.
        Exercise capacity in patients with severe symptomatic aortic stenosis before and six months after transcatheter aortic valve implantation.
        Am J Cardiol. 2011; 108: 258-264
        • Abdul-Jawad Altisent O
        • Puri R
        • Regueiro A
        • Chamandi C
        • Rodriguez-Gabella T
        • Del Trigo M
        • Campelo-Parada F
        • Couture T
        • Marsal JR
        • Côté M
        • Paradis J-M
        • DeLarochellière R
        • Doyle D
        • Mohammadi S
        • Dumont E
        • Rodés-Cabau J
        Predictors and association with clinical outcomes of the changes in exercise capacity after transcatheter aortic valve replacement.
        Circulation. 2017; 136: 632-643
        • Eichler S
        • Salzwedel A
        • Reibis R
        • Nothroff J
        • Harnath A
        • Schikora M
        • Butter C
        • Wegscheider K
        • Völler H.
        Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation: predictors of functional and psychocognitive recovery.
        Eur J Prev Cardiol. 2017; 24: 257-264
        • Kee CC
        • Sumarni MG
        • Lim KH
        • Selvarajah S
        • Haniff J
        • Tee GHH
        • Gurpreet K
        • Faudzi YA
        • Amal NM.
        Association of BMI with risk of CVD mortality and all-cause mortality.
        Public Health Nutr. 2017; 20: 1226-1234