Geriatric assessment to objectify the multidisciplinary heart team decision for treatment of elderly patients with severe, symptomatic aortic valve stenosis

Abstract

ObjectivesThe aim of this study was to evaluate which components of the multidimensional geriatric assessment mostly match to the subjective multidisciplinary heart team decision in order to objectify the treatment selection of elderly patients with symptomatic severe aortic valve stenosis (AVS). MethodsOne hundred and thirteen elderly patients with severe, symptomatic AVS underwent standardized multidimensional geriatric assessment, independent of the clinical multidisciplinary heart team evaluation, for final treatment strategy selection: (1) surgery, if not: (2) transcatheter aortic valve implantation (TAVI) or conservative treatment. ResultsBased on multivariate analyses, parameters of the standardized geriatric assessment mostly paralleling the multidisciplinary heart team's decision to surgery were age [odds ratio (OR): 0.867, P=0.007), logistic EuroSCORE (OR: 0.854, P=0.001) and Katz independence (OR: 6.747, P=0.001)]. Parameters mostly paralleling the multidisciplinary heart team's decision to TAVI were Katz bathing (OR: 3.947, P=0.056), mobility (OR: 3.737, P=0.023) and calf muscle circumference (OR: 1.231, P=0.010). STS score (OR: 1.411, P=0.006), Katz independence (OR: 0.190, P=0.026) and Mini-Nutritional Assessment-short-form (OR: 0.631, P=0.015) mostly paralleled the multidisciplinary heart team's decision to conservative treatment. ConclusionIn this single center prospective study, selected objective geriatric characteristics can be used as an alternative to the more subjective process of the multidisciplinary heart team treatment decision in elderly patients with severe, symptomatic AVS, by this potentially making treatment decision less heart team dependent.