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Ralf Seipelt - One of the best experts on this subject based on the ideXlab platform.
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impact of frailty on short and long term morbidity and mortality after transcatheter aortic valve implantation risk assessment by Katz Index of activities of daily living
Eurointervention, 2014Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Annalen Bleckmann, Bernhard C. Danner, Mark Hünlich, Friedrich A. Schöndube, Tim Beisbarth, Gerd Hasenfus, Ralf SeipeltAbstract:AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3%, p=0.04 for immediate procedural mortality; 17% vs. 5.8%, p=0.002 for 30-day mortality; and 23% vs. 6.4%, p<0.0001 for procedural mortality). The risk-score-based 30-day mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) reflected neither the observed 30-day mortality in both groups nor the threefold risk elevation in frail patients. In contrast, the Katz Index <6 was identified as a significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67 [95% CI: 1.7-4.3], p<0.0001). During follow-up (median observation period 537 days) 56% of frail vs. 24% of non-frail patients died. CONCLUSIONS: Frailty status measured by the Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVI-specific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.
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Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living.
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2014Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Gerd Hasenfuss, Annalen Bleckmann, Bernhard C. Danner, Mark Hünlich, Tim Beißbarth, Friedrich A. Schöndube, Ralf SeipeltAbstract:AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index
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Katz-Index effectively predicts long-term mortality after Transcatheter Aortic Valve Implantation (TAVI)
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, B.c. Danner, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index
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Katz Index effectively predicts long term mortality after transcatheter aortic valve implantation tavi
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, B Danner, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index <6 (HR 2.81, P<0.0001). Whereas mortality in independent persons (Katz Index =6) was 17% at 1 year and 25% at 2 years, it raised to 39% at 1 year and 48% at 2 years in patients with a Katz Index <6. Of the 115 patients who had deceased at time of follow-up, 79 had had a Katz Index <6 before TAVI. Conclusions: The Katz Index (which can be evaluated quickly and without technical aid) represents a valid tool for the identification of patients with good long-term survival who particularly benefit from TAVI. Therefore, in our opinion the Katz Index should be taken into consideration when a patient's indication for TAVI is under discussion.
Miriam Puls - One of the best experts on this subject based on the ideXlab platform.
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impact of frailty on short and long term morbidity and mortality after transcatheter aortic valve implantation risk assessment by Katz Index of activities of daily living
Eurointervention, 2014Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Annalen Bleckmann, Bernhard C. Danner, Mark Hünlich, Friedrich A. Schöndube, Tim Beisbarth, Gerd Hasenfus, Ralf SeipeltAbstract:AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3%, p=0.04 for immediate procedural mortality; 17% vs. 5.8%, p=0.002 for 30-day mortality; and 23% vs. 6.4%, p<0.0001 for procedural mortality). The risk-score-based 30-day mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) reflected neither the observed 30-day mortality in both groups nor the threefold risk elevation in frail patients. In contrast, the Katz Index <6 was identified as a significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67 [95% CI: 1.7-4.3], p<0.0001). During follow-up (median observation period 537 days) 56% of frail vs. 24% of non-frail patients died. CONCLUSIONS: Frailty status measured by the Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVI-specific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.
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Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living.
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2014Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Gerd Hasenfuss, Annalen Bleckmann, Bernhard C. Danner, Mark Hünlich, Tim Beißbarth, Friedrich A. Schöndube, Ralf SeipeltAbstract:AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index
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Katz-Index effectively predicts long-term mortality after Transcatheter Aortic Valve Implantation (TAVI)
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, B.c. Danner, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index
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Katz Index effectively predicts long term mortality after transcatheter aortic valve implantation tavi
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, B Danner, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index <6 (HR 2.81, P<0.0001). Whereas mortality in independent persons (Katz Index =6) was 17% at 1 year and 25% at 2 years, it raised to 39% at 1 year and 48% at 2 years in patients with a Katz Index <6. Of the 115 patients who had deceased at time of follow-up, 79 had had a Katz Index <6 before TAVI. Conclusions: The Katz Index (which can be evaluated quickly and without technical aid) represents a valid tool for the identification of patients with good long-term survival who particularly benefit from TAVI. Therefore, in our opinion the Katz Index should be taken into consideration when a patient's indication for TAVI is under discussion.
B Sobisiak - One of the best experts on this subject based on the ideXlab platform.
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Einfluss der Gebrechlichkeit auf Morbidität und Mortalität nach kathetergestützter Aortenklappenimplantation (TAVI)
2017Co-Authors: B SobisiakAbstract:Background: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by Katz Index of Activities of Daily Living (ADL) on short- and long-term mortality after TAVI. Methods and Results: Our study includes 300 consecutive patients (mean age, 82±5 years) who underwent TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index
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impact of frailty on short and long term morbidity and mortality after transcatheter aortic valve implantation risk assessment by Katz Index of activities of daily living
Eurointervention, 2014Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Annalen Bleckmann, Bernhard C. Danner, Mark Hünlich, Friedrich A. Schöndube, Tim Beisbarth, Gerd Hasenfus, Ralf SeipeltAbstract:AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3%, p=0.04 for immediate procedural mortality; 17% vs. 5.8%, p=0.002 for 30-day mortality; and 23% vs. 6.4%, p<0.0001 for procedural mortality). The risk-score-based 30-day mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) reflected neither the observed 30-day mortality in both groups nor the threefold risk elevation in frail patients. In contrast, the Katz Index <6 was identified as a significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67 [95% CI: 1.7-4.3], p<0.0001). During follow-up (median observation period 537 days) 56% of frail vs. 24% of non-frail patients died. CONCLUSIONS: Frailty status measured by the Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVI-specific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.
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Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living.
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2014Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Gerd Hasenfuss, Annalen Bleckmann, Bernhard C. Danner, Mark Hünlich, Tim Beißbarth, Friedrich A. Schöndube, Ralf SeipeltAbstract:AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index
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Katz-Index effectively predicts long-term mortality after Transcatheter Aortic Valve Implantation (TAVI)
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, B.c. Danner, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index
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Katz Index effectively predicts long term mortality after transcatheter aortic valve implantation tavi
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, B Danner, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index <6 (HR 2.81, P<0.0001). Whereas mortality in independent persons (Katz Index =6) was 17% at 1 year and 25% at 2 years, it raised to 39% at 1 year and 48% at 2 years in patients with a Katz Index <6. Of the 115 patients who had deceased at time of follow-up, 79 had had a Katz Index <6 before TAVI. Conclusions: The Katz Index (which can be evaluated quickly and without technical aid) represents a valid tool for the identification of patients with good long-term survival who particularly benefit from TAVI. Therefore, in our opinion the Katz Index should be taken into consideration when a patient's indication for TAVI is under discussion.
Claudius Jacobshagen - One of the best experts on this subject based on the ideXlab platform.
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impact of frailty on short and long term morbidity and mortality after transcatheter aortic valve implantation risk assessment by Katz Index of activities of daily living
Eurointervention, 2014Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Annalen Bleckmann, Bernhard C. Danner, Mark Hünlich, Friedrich A. Schöndube, Tim Beisbarth, Gerd Hasenfus, Ralf SeipeltAbstract:AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3%, p=0.04 for immediate procedural mortality; 17% vs. 5.8%, p=0.002 for 30-day mortality; and 23% vs. 6.4%, p<0.0001 for procedural mortality). The risk-score-based 30-day mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) reflected neither the observed 30-day mortality in both groups nor the threefold risk elevation in frail patients. In contrast, the Katz Index <6 was identified as a significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67 [95% CI: 1.7-4.3], p<0.0001). During follow-up (median observation period 537 days) 56% of frail vs. 24% of non-frail patients died. CONCLUSIONS: Frailty status measured by the Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVI-specific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.
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Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living.
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2014Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Gerd Hasenfuss, Annalen Bleckmann, Bernhard C. Danner, Mark Hünlich, Tim Beißbarth, Friedrich A. Schöndube, Ralf SeipeltAbstract:AIMS: Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. METHODS AND RESULTS: Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index
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Katz-Index effectively predicts long-term mortality after Transcatheter Aortic Valve Implantation (TAVI)
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, B.c. Danner, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index
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Katz Index effectively predicts long term mortality after transcatheter aortic valve implantation tavi
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, B Danner, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index <6 (HR 2.81, P<0.0001). Whereas mortality in independent persons (Katz Index =6) was 17% at 1 year and 25% at 2 years, it raised to 39% at 1 year and 48% at 2 years in patients with a Katz Index <6. Of the 115 patients who had deceased at time of follow-up, 79 had had a Katz Index <6 before TAVI. Conclusions: The Katz Index (which can be evaluated quickly and without technical aid) represents a valid tool for the identification of patients with good long-term survival who particularly benefit from TAVI. Therefore, in our opinion the Katz Index should be taken into consideration when a patient's indication for TAVI is under discussion.
Wolfgang Schillinger - One of the best experts on this subject based on the ideXlab platform.
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Katz-Index effectively predicts long-term mortality after Transcatheter Aortic Valve Implantation (TAVI)
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, B.c. Danner, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index
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Katz Index effectively predicts long term mortality after transcatheter aortic valve implantation tavi
European Heart Journal, 2013Co-Authors: Miriam Puls, B Sobisiak, Claudius Jacobshagen, B Danner, Friedrich A Schoendube, Gerd Hasenfuss, Ralf Seipelt, Wolfgang SchillingerAbstract:Purpose: Mid- and long-term mortality after TAVI is considerable due to relevant co-morbidities and high age in this specific patient cohort. The exploration of potential prognostic predictors for the identification of patients who are able to gain long-term benefit from this procedure is therefore indispensable. Methods: We investigated the ability of different surgical scores (log. EuroSCORE I, EuroSCORE II, STS-score) and of the Katz Index (a geriatric tool for assessing a patient's ability to perform activities of daily living in 6 categories) to predict long-term survival. These scores were evaluated in the first 300 consecutive patients (198 women, 102 men; mean age 82±5 years) who underwent TAVI at our clinic between August 2008 and February 2012 (158 transapical and 142 transfemoral procedures, 272 Edwards Sapien and 28 Medtronic CoreValve implantations). All patients were followed by telephone contact in 2012, and all relevant medical documents were acquired to investigate the incidence and causes of death. Survival analysis was performed by the Kaplan-Meier method. Results: The total cohort was characterized by a high risk for conventional surgery estimated by a mean logistic EuroScore I of 26±15%, EuroSCORE II of 8.5±7.6%, and STS score of 7.3±5.4%. 155 patients could be classified as completely independent in activities of daily living (Katz Index = 6). During a median follow-up of 529 days, 115 patients had died. Total mortality was 11.3% at 30 days, 27.6% at 1 year, and 36.7% at 2 years. All surgical scores proved to be significant predictors of survival. The highest predictive value concerning all-cause mortality during follow-up exhibited the EuroSCORE II with a cut-off ≥10% (HR 2.76, P 20% (HR 2.03, P=0.0005). However, the best prognosis of long-term mortality was enabled by a Katz Index <6 (HR 2.81, P<0.0001). Whereas mortality in independent persons (Katz Index =6) was 17% at 1 year and 25% at 2 years, it raised to 39% at 1 year and 48% at 2 years in patients with a Katz Index <6. Of the 115 patients who had deceased at time of follow-up, 79 had had a Katz Index <6 before TAVI. Conclusions: The Katz Index (which can be evaluated quickly and without technical aid) represents a valid tool for the identification of patients with good long-term survival who particularly benefit from TAVI. Therefore, in our opinion the Katz Index should be taken into consideration when a patient's indication for TAVI is under discussion.