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Functional continuum: independent predictor of one-year mortality and key decision-making element in older adults with severe aortic stenosis amenable to aortic valve replacement

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Abstract

Objectives

The impact of functional capacity over the entire functional continuum in older adults undergoing aortic valve replacement (AVR) has not been studied to date.

This study aims to analyze 1.- the distribution of a cohort of older adults presenting severe aortic stenosis (AS) amenable to AVR in the different categories of the Functional Continuum Scale (FCS); 2.- its association with decision-making regarding valve disease; and 3.- its impact upon the one-year mortality rate of surgical (SAVR), transcatheter (TAVR) aortic valve replacement, or the decision to provide conservative management (OMT).

Methods

This prospective study included patients from the FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry evaluated by the reference Heart-Team of a region in northern Spain. All the patients underwent comprehensive geriatric assessment.

Results

The study comprised 257 patients aged 84.0 ± 3.9 years. Management: SAVR: 25.3%, TAVR: 58.0% and OMT: 16.7%. Increased patient functional capacity was associated with an increased tendency to perform more invasive valve disease treatment. The overall one-year survival rate was 81.3%. One-year all-cause mortality: FCS-1 to FCS-2 "robust" 11.5%, FCS-3 to FCS-4 "prefrail" 14.7%, FCS-5 "frail" 19.2% and FCS-6 to FCS-8 "dependent" 45.0%; p < 0.001. Adjusted mortality analysis: FCS with HR = 1.206 [95%CI, 0.999–1.451 (p = 0.051)]; EuroSCORE-II with HR = 1.071 [95%CI, 1.006–1.161 (p = 0.033)]; and OMT with HR = 2.840 [95%CI, 1.409–5.772 (p = 0.004)] were retained in the final multivariable logistic regression model.

Conclusions

In older AS patients amenable to AVR, the FCS is a useful predictive tool that may aid clinical decision-making.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain

    Pablo Solla-Suárez, Marta Fernández-Fernández, Carmen Moreno-Planillo, Eva López-Álvarez & José Gutiérrez-Rodríguez

  2. Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain

    Pablo Avanzas, Isaac Pascual, Marcel Almendárez, Rut Álvarez & César Morís

  3. Health Research Institute of Asturias, ISPA, Oviedo, Spain

    Pablo Solla-Suárez, Pablo Avanzas, Isaac Pascual, Marcel Almendárez, Rut Álvarez, Ana Coto-Montes, César Morís & José Gutiérrez-Rodríguez

  4. University of Oviedo, UOV, Oviedo, Spain

    Pablo Avanzas, Isaac Pascual, Ana Coto-Montes & César Morís

  5. Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain

    Ana Coto-Montes

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Solla-Suárez, P., Avanzas, P., Fernández-Fernández, M. et al. Functional continuum: independent predictor of one-year mortality and key decision-making element in older adults with severe aortic stenosis amenable to aortic valve replacement. Aging Clin Exp Res 35, 323–331 (2023). https://doi.org/10.1007/s40520-022-02300-y

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