Identification Of Seniors At Risk Score Research Articles

Hyponatremia and Identification of Seniors at Risk (ISAR) Score in Geriatric Patients: An Analytical Cross-Sectional Study.

Aim and objective Hyponatremia is the most common electrolyte abnormality in hospitalized patients. Age is an important, strong independent factor for hyponatremia. Geriatric at-risk groups are identified with six straightforward dichotomous questions. The research aims to determine the incidence of hyponatremia and correlate the identification of seniors at risk (ISAR) score with electrolytes in elderly individuals. Materials and methods The 334 geriatric population of elderly men and women were recruited based on age cut-off as more than 70 to 75, 76 to 80, and more than 80. Patients were categorized based on serum sodium levels as severe hyponatremia group A (< 125 mEq/L), moderate hyponatremia B (126 to 130 mEq/L), mild hyponatremia C (131 to 135 mEq/L) and normonatremia D (136 to 145 mEq/L). At the time of admission, the ISAR Tool was utilized to identify the participants with hyponatremia at risk. Electrolytes sodium, potassium, and chloride were analyzed in the Beckman Coulter AU480 autoanalyzer by indirect ISE method. The mean of the data was compared with ANOVA, and the ISAR risk score was correlated with electrolytes by Pearson correlation analysis; p < 0.5 is considered significant. Results and discussion About 16.76 % (56 patients) had severe hyponatremia (Serum sodium 119.14± 4.14 mEq/L) with a high ISARscore (6.0) and were reported as critical alert results by the central laboratory. Based on age-wise category, 70 to 75 yrs had serum sodium levels of 133.82 mEq/L, 76 to 80 yrs had 128.4 mEq/L, and more than 80 years had serum hyponatremia 119.17 mEq/L. Geriatrics with normonatremia had a 1.22 ISAR score, whereas geriatrics with severe hyponatremia had a 6.0 ISAR score. Correlation analysis of the ISAR score revealed a statistically significant negative correlation with sodium (r = - 0.53), potassium (r = - 0.34), and chloride (r = - 0.30) levels. Likewise, the length of hospital stay of the geriatrics with severe hyponatremia was prolonged (19 days), which contributed to the deterioration of health status; thereby, better healthcare follow-up is encouraged. Conclusion Hyponatremia is a critical alert analyte that is common in hospitalized geriatric patients. The ISAR score system points towards the individuals who are at risk and need immediate correction. Thereby, correction of sodium levels and close monitoring of the elderly patient enables quick recovery, and the consequences of hyponatremia are circumvented.

1081 A COMPARISON OF THE ISAR TOOL AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED REATTENDANCE IN A COHORT OF ED ATTENDER

Abstract Background Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department. Method This was a prospective cohort study. Patients over 65 were recruited, baseline. demographics were obtained and a research nurse assessed them using both the Clinical Frailty Scale and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation. Results 419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). The median ISAR and CFS score was 2,5 respectively at baseline. The mortality rate was 5.4% and rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score &amp;gt;/= 2 more was 1.84 (1.12, 3.02) and CFS &amp;gt; 4 was 1.85 (1.08, 3.16). The ISAR tool &amp;gt;/= 2, had a sensitivity of 74.29 (95% CI = 62.44, 83.99) and specificity of 41.18 (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS &amp;gt; 4 had a sensitivity of 71.43 (95% CI = 57.79, 82.70) and specificity of 45.23 (95% CI = 39.33, 51.23) for the same outcome. Conclusion The ISAR tool &amp;gt;/= 2 was the more sensitive at predicting ED reattendance at one month in comparison to the Clinical Frailty Scale. We would advocate using this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.

Population Pharmacokinetic Model for Tramadol and O-desmethyltramadol in Older Patients.

Background and ObjectivesTramadol is commonly prescribed to manage chronic pain in older patients. However, there is a gap in the literature describing the pharmacokinetic parameters for tramadol and its active metabolite (O-desmethyltramadol [ODT]) in this population. The objective of this study was to develop and evaluate a population pharmacokinetic model for tramadol and ODT in older patients.MethodsTwenty-one patients who received an extended-release oral tramadol dose (25–100 mg) were recruited. Tramadol and ODT concentrations were determined using a validated liquid chromatography/tandem mass spectrometry method. A population pharmacokinetic model was developed using non-linear mixed-effects modelling. The performance of the model was assessed by visual predictive check.ResultsA two-compartment, first-order absorption model with linear elimination best described the tramadol concentration data. The absorption rate constant was 2.96/h (between-subject variability [BSV] 37.8%), apparent volume of distribution for the central compartment (V1/F) was 0.373 l (73.8%), apparent volume of distribution for the peripheral compartment (V2/F) was 0.379 l (97.4%), inter-compartmental clearance (Q) was 0.0426 l/h (2.19%) and apparent clearance (CL/F) was 0.00604 l/h (6.61%). The apparent rate of metabolism of tramadol to ODT (kt) was 0.0492 l/h (78.5%) and apparent clearance for ODT (CLm) was 0.143 l/h (21.6%). Identification of Seniors at Risk score (ISAR) and creatinine clearance (CrCL) were the only covariates included in the final model, where a higher value for the ISAR increased the maximum concentration (Cmax) of tramadol and reduced the BSV in Q from 4.71 to 2.19%. A higher value of CrCL reduced tramadol Cmax and half-life (T1/2) and reduced the BSV in V2/F (from 148 to 97.4%) and in CL/F (from 78.9 to 6.61%).ConclusionExposure to tramadol increased with increased frailty and reduced CrCL. Prescribers should consider patients frailty status and CrCL to minimise the risk of tramadol toxicity in such cohort of patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13318-022-00756-x.

240 A COMPARISON OF THE ISAR AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED RE-ATTENDANCE IN OLDER ED ATTENDERS

Abstract Background Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale (CFS) are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department. Methods This was a prospective cohort study. Patients over 65 were recruited, baseline demographics were obtained and a research nurse assessed them using both the CFS and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation. Results 419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). At baseline, the median ISAR was 2 and CFS was 5. The mortality rate was 5.4% and the rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score ≥ 2 was 1.84 (1.12, 3.02) and CFS &amp;gt; 4 was 1.85 (1.08, 3.16). The ISAR tool ≥2 had a sensitivity of 74% (95% CI = 62.44, 83.99) and specificity of 41% (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS &amp;gt; 4 had a sensitivity of 71% (95% CI = 57.79, 82.70) and specificity of 45% (95% CI = 39.33, 51.23) for ED re-attendance. Conclusion The ISAR tool ≥2 was more sensitive at predicting ED reattendance at one month in comparison to the CFS. We advocate to use this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.

A new simplified model for predicting 30-day mortality in older medical emergency department patients: The rise up score

Background/ObjectivesCurrently, accurate clinical models that predict short-term mortality in older (≥ 65 years) emergency department (ED) patients are lacking. We aimed to develop and validate a prediction model for 30-day mortality in older ED patients that is easy to apply using variables that are readily available and reliably retrievable during the short phase of an ED stay. MethodsProspective multi-centre cohort study in older medical ED patients. The model was derived through logistic regression analyses, externally validated and compared with other well-known prediction models (Identification of Seniors at Risk (ISAR), ISAR-Hospitalised Patients, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Modified Early Warning Score (MEWS)). ResultsWithin 30 days after presentation, 66 (10.9%) of 603 patients in the derivation cohort and 105 (13.3%) of 792 patients in the validation cohort died. The newly developed model included 6 predictors: age, ≥2 abnormal vital signs, serum albumin, blood urea nitrogen, lactate dehydrogenase, and bilirubin. The discriminatory value of the model for mortality was very good with an AUC of 0.84 in the derivation and 0.83 in the validation cohort. The final model was excellently calibrated (Hosmer-Lemeshow p-value 0.89). The discriminatory value of the model was significantly higher than that of the four risk stratification scores (highest AUC of 0.69 for ISAR score, p-value 0.007). ConclusionWe developed and externally validated an accurate and simplified prediction model for 30-day mortality in older ED patients. This model may be useful to identify patients at risk of short-term mortality and to apply personalised medical care.

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

BackgroundThe rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients.MethodsTwo hundred forty-two in-patients (57.4% male) aged 78.4 ± 6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs.ResultsThe 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy.In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β = − 0.19, 95% confidence interval (CI) = − 0.66;-0.13), number of admission diagnoses (β = 0.28, 95% CI = 0.16;0.41), ADL impairment (B = 6.66, 95% CI = 3.312;10.01), and signs of depression (B = 6.69, 95% CI = 1.43;11.94) independently predicted length of hospital stay. ADL impairment (B = 1.14, 95%CI = 0.67;1.61), cognition impairment (B = 0.57, 95% CI = 0.07;1.07) and ISAR score (β =0.26, 95% CI = 0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR) = 1.06, 95% CI = 1.04;1.08), ADL impairment (RR = 3.54, 95% CI = 2.29;5.47), cognition impairment (RR = 1.77, 95% CI = 1.20;2.62) and signs of depression (RR = 1.99, 95% CI = 1.39;2.85) predicted receiving physiotherapy.ConclusionAmong older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

Health outcome of older hospitalized patients in internal medicine environments evaluated by Identification of Seniors at Risk (ISAR) screening and geriatric assessment

BackgroundHospitals are in need of valid and economic screening and assessment tools that help identifying older patients at risk for complications which require intensified support during their hospital stay.MethodsFive hundred forty-seven internal medicine in-patients (mean age 78.14 ± 5.96 years; 54.7% males) prospectively received Identification of Seniors at Risk (ISAR) screening. If screening results were positive (ISAR score ≥ 2), a comprehensive geriatric assessment (CGA) was performed. We explored sensitivity and specificity of different ISAR and CGA cutoffs. Further, we analyzed the risk of falls and how patients got discharged from hospital.ResultsISAR+/CGA abnormal patients spent more days in hospital (16.1 ± 14.5), received more nursing hours per day (3.0 ± 2.3), more hours of physiotherapy during their hospital stay (2.2 ± 3.2), and had more falls (10.1%) compared to ISAR+/CGA normal (10.9 ± 12.3, 2.0 ± 1.2, 1.2 ± 4.3, and 2.8%, respectively, all p ≤ 0.016) and ISAR- (9.6 ± 11.5, 2.3 ± 4.5, 0.7 ± 2.0, and 2.2%, respectively, all p ≤ 0.002) patients. ISAR+/CGA abnormal patients terminated their treatment regularly with being discharged back home less often (59.6%) compared to ISAR+/CGA normal (78.5%, p = 0.002) and ISAR- (78.2%, p = 0.056) patients. ISAR cutoff≥2 and CGA defined as abnormal in case of impairment of ADL plus another CGA domain achieved best sensitivity/specificity.ConclusionsAbnormal geriatric risk screening and assessment are associated with longer hospital stay and higher amount of nursing and physiotherapy during hospital stay, greater risk of falling, and a lower percentage of successfully terminated treatment in older in-patients.

Does the identification of seniors at risk (ISAR) score effectively select geriatric patients on emergency admission?

The number of older patients admitted to emergency departments (ED) increases continuously. The Identification of Seniors at Risk (ISAR) score is currently recommended to screen patients in German ED, but its appropriateness is being criticized. ISAR scores and clinical characteristics from 98 emergency admissions (EA), 80 from acute geriatrics (AG) and 89 from a geriatric rehabilitation (GR) unit were compared retrospectively. No significant differences were found between groups, being the ISAR score positive in 87.7% of EA, 94.9% of AG and 94.4% of GR cases. None of positively identified geriatric patients in the EA was transferred to the geriatric ward of competence. EA patients showed significantly higher number of functional impairments (p = 0.001) and higher BI score (p < 0.0001) compared to AG and GR groups. A higher ISAR score threshold and additional functional information might be needed to better select patients in need of prompt treatment by a geriatric team.

Identification of hospitalized elderly patients at risk for adverse in-hospital outcomes in a university orthopedics and trauma surgery environment.

BackgroundAs a consequence of demographic changes, hospitals are confronted with increasing numbers of elderly patients, who are at high risk of adverse events during hospitalization. Geriatric risk screening followed by comprehensive geriatric assessment (CGA) and treatment has been requested by geriatric societies and task forces to identify patients at risk. Since empirical evidence on factors predisposing to adverse hospital events is scarce, we now prospectively evaluated implications of geriatric risk screening followed by CGA in a university hospital department of orthopedics and trauma surgery.MethodsThree hundred and eighty-one patients ≥75 years admitted to the Department of Orthopedics and Trauma Surgery of the University Hospital Essen received Identification of Seniors at Risk (ISAR) Screening followed by CGA via a geriatric liaison service in case of positive screening results. Associations between ISAR, CGA, comorbid risk factors and diseases, length of hospital stay, number of nursing and physiotherapy hours, and falls during hospital stay were analyzed.ResultsOf 381 ISAR screenings, 327 (85.8%) were positive, confirming a high percentage of patients at risk of adverse events. Of these, 300 CGAs revealed 82.7% abnormal results, indicating activities of daily living impairment combined with cognitive, emotional or mobility disturbances. Abnormal CGA resulted in a longer hospital stay (14.0±10.3 days in ISAR+/CGA abnormal compared with 7.6±7.0 days in ISAR+/CGA normal and 8.1±5.4 days in ISAR-, both p<0.001), increased nursing hours (3.4±1.1 hours/day in ISAR+/CGA abnormal compared with 2.5±1.0 hours/day in ISAR+/CGA normal and 2.2±0.8 hours/day in ISAR-, both p<0.001), and increased falls (7.3% in ISAR+/CGA abnormal, 0% in ISAR+/CGA normal, 1.9% in ISAR-). Physiotherapy hours were only significantly increased in ISAR+/CGA abnormal (3.0±2.7 hours) compared with in ISAR+/CGA normal (1.6±1.4 hours, p<0.001) whereas the comparison with ISAR- (2.4±2.4 hours) did not reach significance (p = 0.368). In multivariable regressions, the CGA domains activities of daily living impairment (assessed by Barthel-Index) and signs of depression (assessed by geriatric depression scale) predicted longer length of hospital stay. High ISAR score, and impairment in activities of daily living and cognition (assessed by mini-mental state examination and clock-drawing test) predicted increased nursing hours, and impairment in activities of daily living and mobility predicted increased physiotherapy hours.ConclusionsAn abnormal geriatric screening and assessment is associated with longer hospital stay, more nursing and physiotherapy hours, and more falls.

Adverse outcomes in older adults attending emergency departments: a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool.

older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care. to perform a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool, to determine its predictive value in identifying adults ≥65 years at risk of functional decline, unplanned emergency department (ED) readmission, emergency hospitalisation or death within 180 days after index ED visit/hospitalisation. a systematic literature search was conducted in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library to identify validation and impact analysis studies of the ISAR tool. A pre-specified ISAR score of ≥2 (maximum score 6 points) was used to identify patients at high risk of adverse outcomes. A bivariate random effects model generated pooled estimates of sensitivity and specificity. Statistical heterogeneity was explored and methodological quality was assessed using validated criteria. thirty-two validation studies (n = 12,939) are included. At ≥2, the pooled sensitivity of the ISAR for predicting ED return, emergency hospitalisation and mortality at 6 months is 0.80 (95% confidence interval (CI) 0.70-0.87), 0.82 (95% CI 0.74-0.88) and 0.87 (95% CI 0.75-0.94), respectively, with a pooled specificity of 0.31 (95% CI 0.24-0.38), 0.32 (95% CI 0.24-0.41) and 0.35 (95% CI 0.26-0.44). Similar values are demonstrated at 30 and 90 days. Three heterogeneous impact analysis studies examined the clinical implementation of the ISAR and reported mixed findings across patient and process outcomes. the ISAR has modest predictive accuracy and may serve as a decision-making adjunct when determining which older adults can be safely discharged.

LO054: The emergency department usage and utility of ISAR and CAM assessment tools in identifying hip fracture patients at risk for developing delirium

Introduction: Delirium is an acute state of mental confusion that is a frequent complication in older adults with a hip fracture, and is often unrecognized by clinicians in the emergency department (ED). It is associated with prolonged hospitalization, functional decline, hospital readmission, and death. The Identification of Seniors At Risk (ISAR) and Confusion Assessment Method (CAM) are two standardized tools designed to facilitate prompt screening and detection of functional decline and delirium respectively amongst adults 65 and older. The objective of this study was to determine the ED usage and utility of ISAR and CAM assessment tools in identifying hip fracture patients at risk for developing delirium. Methods: This was a retrospective chart review of patients aged 65 and older, presenting to an academic ED (annual census 60,000) with a discharge diagnosis of hip fracture from January 1st 2014 to July 31st 2015. At this institution, both the ISAR and CAM are included in the standard ED nursing documentation and are intended to be completed for all patients over 65 years of age. Results: Of the 243 hip fracture cases included in this study, the ISAR and CAM scores were completed for 131 (53.9%) and 69 (28.4%) patients, respectively. There were 43 (17.7%) cases of recorded in-hospital acute delirium. Of the delirium cases, 20 (46.5%) had an ISAR assessment. Patients with an ISAR score of ≥3 were more likely to experience delirium compared to those with lower ISAR scores (28.3% vs 8.3%; Δ 20.0%, 95% CI: 6.6%, 34.9%). Of the 43 patients with delirium, 11 (25.6%) had a CAM score recorded. Patients with a positive CAM score (meeting 3 of 4 criteria in the diagnostic algorithm) were more likely to experience delirium compared to those with negative CAM scores (66.7% vs 11.1%; Δ 55.6%, 95% CI: 17.5%, 79.9%). Conclusion: Vigilant efforts are needed to ensure these screening tools are applied for all patients over the age of 65 presenting to the ED to improve the recognition and early management of delirium. Future research should focus on initiatives to improve delirium screening compliance by ED personnel.

Evaluation of preoperative geriatric assessment of elderly patients with colorectal carcinoma. A retrospective study

AimsElderly patients with colorectal carcinoma are screened with the Identification of Seniors at Risk (ISAR) questionnaire to identify frail patients. These patients are more at risk for mortality and morbidity and are referred to the geriatric specialist for assessment (Dutch acronym: DOG). The DOG assessment aims to preoperatively optimize the patient in order to improve postoperative outcomes.This study evaluates if the DOG assessment influences postoperative outcome after colorectal surgery. MethodsRetrospective cohort and match-control study. Elderly patients who underwent elective resection between 01-01-2008 and 01-08-2013 in the Medical Centre Alkmaar were included.Patients with a positive ISAR score were referred to the geriatric specialists for DOG assessment (DOG patients).DOG assessment encompassed comprehensive geriatric assessment and interventions. Primary outcomesMortality, delirium and length of hospital stay. Secondary outcomes: postoperative complications. Cohort comparisonCohort ISAR− (2008–2010, no ISAR questionnaire) is compared with cohort ISAR+ (2011–2013, ISAR questionnaire). Match-control comparison: DOG patients are compared with matched controls from cohort ISAR−. ResultsCompared to their matched controls, DOG patients were older and had a higher prevalence of certain risk factors for postoperative delirium. In both comparisons, no statistical significant differences were found between the groups in mortality and postoperative delirium. Length of stay was significantly shorter in cohort ISAR+. ConclusionsWhile the DOG patients were significantly more at risk for postoperative complications, the DOG patients had comparable postoperative outcomes as their matched controls. We therefore conclude that the DOG assessment has a positive influence on the postoperative outcomes after colorectal surgery.

Predictive Validity of the Identification of Seniors at Risk Screening Tool in a German Emergency Department Setting

Background: The identification of patients at high risk for adverse outcomes [death, unplanned readmission to emergency department (ED)/hospital, functional decline] plays an important role in emergency medicine. The Identification of Seniors at Risk (ISAR) instrument is one of the most commonly used and best-validated screening tools. As to the authors' knowledge so far there are no data on any screening tool for the identification of older patients at risk for a negative outcome in Germany. Objectives: To evaluate the validity of the ISAR screening tool in a German ED. Design: This was a prospective single-center observational cohort study in an ED of an urban university-affiliated hospital. Participants were 520 patients aged ≥75 years consecutively admitted to the ED. Measurements: The German version of the ISAR screening tool was administered directly after triage of the patients. Follow-up telephone interviews to assess outcome variables were conducted 28 and 180 days after the index visit in the ED. The primary end point was death from any cause or hospitalization or recurrent ED visit or change of residency into a long-term care facility on day 28 after the index ED visit. Results: The mean age ± SD was 82.8 ± 5.0 years. According to ISAR, 425 patients (81.7%) scored ≥2 points, and 315 patients (60.5%) scored ≥3 points. The combined primary end point was observed in 250 of 520 patients (48.1%) on day 28 and in 260 patients (50.0%) on day 180. Using a continuous ISAR score the area under the curve on day 28 was 0.621 (95% confidence interval, CI 0.573-0.669) and 0.661 (95% CI 0.615-0.708) on day 180, respectively. Conclusion: The German version of the ISAR screening tool acceptably identified elderly patients in the ED with an increased risk of a negative outcome. Using the cutoff ≥3 points instead of ≥2 points yielded better overall results.

Impact of frailty scores on outcome of octogenarian patients undergoing transcatheter aortic valve implantation

Background For selected patients with symptomatic aortic stenosis, transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR). In addition to co-morbidities, frailty has to be taken into account in the decision-making process. Criteria for patient selection, according to current guidelines, include EuroSCORE and STS score but frailty is not easy to quantify. ISAR (Identifi cation of Seniors At Risk) detects seniors at risk for adverse health outcome after an emergency visit and SHERPA (Score Hospitalier d’Evaluation du Risque de Perte d’Autonomie) assesses the risk of functional decline after hospitalization.Objectives The aim of the present study was to evaluate the impact of ISAR and SHERPA scores in the prediction of patient outcome after TAVI.Methods and results A prospective cohort of 30 consecutive octogenarian patients (16 males, 86 ± 3 y, EuroSCORE 34 ± 12%) underwent a transfemoral TAVI and a complete geriatric assessment in our institution. Survival at one year was 73%. The ISAR score was similar between both groups (3.1 ± 1 vs. 3.6 ± 1; P = 0.10) but the SHERPA score was signifi cantly higher in non-survivors (7.8 ± 1.6) than among survivors (4.9 ± 2.4; P = 0.001). With multivariate analysis, SHERPA score and BMI were independent predictors of 1-year mortality. Kaplan-Meier analysis showed that 1-year survival was signifi cantly lower in patients with than in those without a SHERPA score > 7 (40 vs. 89%; P = 0.004).Conclusions The result of this study showed that SHERPA score predicts 1-year survival after transfemoral TAVI and could be considered as a useful frailty score in patient selection.