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Mortality rates in TAVR may be reduced in active adults
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Sedentary patients have a higher risk for mortality and functional decline following transcatheter aortic valve replacement, according to findings from the FRAILTY-AVR study published in JACC: Cardiovascular Interventions.
Janarthanan Sathananthan, MBCHB, MPH, and colleagues sought to assess the distribution and prognostic significance of habitual physical activity in older adults undergoing TAVR.
“In older, high-risk patients referred for transcatheter aortic valve replacement, very low levels of [habitual physical activity] are often observed and attributed to the expected manifestation of severe aortic stenosis,” Sathananthan, of the Centre for Heart Valve Innovation at St. Paul’s Hospital in Vancouver, and colleagues wrote.
The researchers analyzed data from the multicenter FRAILTY-AVR study in which older 755 adults (median age, 84 years) were interviewed to measure kcal per week at baseline and follow-up. The primary endpoint was all-cause mortality at 12 months.
At baseline, the median habitual physical activity was 1,116 kcal per week with 73% of patients performing less than 150 minutes per week of moderate or vigorous habitual physical activity, the researchers wrote.
Sedentary patients were more likely to be older, female, frail, cognitively impaired, depressed and have multimorbidity compared with active adults, Sathananthan and colleagues wrote.
Habitual physical activity was found to be associated with mortality at 12 months, with more activity corresponding to better survival odds (OR = 0.84 per 100 kcal; 95% CI, 0.73-0.98), the researchers wrote. Sedentary behavior was associated with longer length of stay (5 days vs. 4 days; P = .001), discharge to health care facilities (33% vs. 23%; P = .003) and disability (P < .001).
At 12 months, median habitual physical activity among survivors was 933 kcal per week and previously existing frailty independently predicted worsening habitual physical activity following TAVR.
“Whether this decline can be ameliorated by exercise therapy is actively being investigated,” Sathananthan and colleagues wrote. “Notwithstanding, the current study suggests that performing a technically successful TAVR procedure in and of itself is not sufficient to ensure the patient’s functional recovery in the months following the procedure.” – by Earl Holland Jr.
Disclosures: Sathananthan reports he received speaking fees from Edwards Lifesciences. Please see the study for all other authors’ relevant financial disclosures.
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