期刊
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
卷 67, 期 7, 页码 1393-1401出版社
WILEY
DOI: 10.1111/jgs.15867
关键词
delirium; functional status; aortic valve replacement; transcatheter aortic valve replacement
资金
- KL2/Catalyst Medical Research Investigator Training award (an appointed KL2 award)
- Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Research Resources) [KL2 TR001100-01, UL1 TR001102]
- Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health) [KL2 TR001100-01, UL1 TR001102]
- Training Program in Cardiovascular Research award from the National Heart, Lung, and Blood Institute, National Institutes of Health [T32-HL007374]
- National Institute on Aging [R01AG025037, R01AG041785, P30AG031679, R01AG030618, R01AG051658, R24AG054259, K24AG035075]
- Medtronic
- Boston Scientific
- Edwards Lifesciences
- Paul B. Beeson Clinical Scientist Development Award in Aging from the National Institute on Aging [K08AG051187]
- American Federation for Aging Research
- John A. Hartford Foundation
- Atlantic Philanthropies
- the Boston Claude D. Pepper Older Americans Independence Center/Pilot and Exploratory Studies Core [P30AG031679]
- Boston Roybal Center Pilot Award [P30AG048785]
Background Transcatheter aortic valve replacement (TAVR) may be associated with less delirium and allow faster recovery than surgical aortic valve replacement (SAVR). Objective To examine the association of delirium and its severity with clinical and functional outcomes after SAVR and TAVR. Design Prospective cohort study. Setting An academic medical center. Participants A total of 187 patients, aged 70 years and older, undergoing SAVR (N = 77) and TAVR (N = 110) in 2014 to 2016. Measurements Delirium was assessed daily using the Confusion Assessment Method (CAM), with severity measured by the CAM-Severity (CAM-S) score (range = 0-19). Outcomes were prolonged hospitalization (9 days or more); institutional discharge; and functional status, measured by ability to perform 22 daily activities and physical tasks over 12 months. Results SAVR patients had a higher incidence of delirium than TAVR patients (50.7% vs 25.5%; P < .001), despite younger mean age (77.9 vs 83.7 years) and higher baseline Mini-Mental State Examination score (26.9 vs 24.7). SAVR patients with delirium had a shorter duration (2.2 vs 3.4 days; P = .04) with a lower mean CAM-S score (4.5 vs 5.7; P = .01) than TAVR patients with delirium. The risk of prolonged hospitalization in no, mild, and severe delirium was 18.4%, 30.8%, and 61.5% after SAVR (P for trend = .009) and 26.8%, 38.5%, and 73.3% after TAVR (P for trend = .001), respectively. The risk of institutional discharge was 42.1%, 58.3%, and 84.6% after SAVR (P for trend = .01) and 32.5%, 69.2%, and 80.0% after TAVR (P for trend <.001), respectively. Severe delirium was associated with delayed functional recovery after SAVR and persistent functional impairment after TAVR at 12 months. Conclusion Less invasive TAVR was associated with lower incidence of delirium than SAVR. Once delirium developed, TAVR patients had more severe delirium and worse functional status trajectory than SAVR patients did. Registration NCT01845207.
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