Elisabeth Skaar has developed a new frailty score for patients with aortic stenosis, and shown that frail patients are at increased risk of dying within two years of transcathether aortic valve implantation (TAVI).
- Most TAVI patients feel they’ve been involved in decision-making regarding the procedure.
- A novel frailty score predicts mortality after TAVI.
- TAVI patients have fewer symptoms and maintain activity levels after the procedure.
Thesis: Decision-making preceding transcatheter aortic valve implantation in frail older adults
Candidate: Elisabeth Skaar
Time: April 24, 2020 at 12:15
Place: Online-based solution, due to the covid-19 situation
Link to university website (in Norwegian)
(1) Aortic stenosis patients offered TAVI generally trust their doctor’s advice, but also feel they have an autonomous choice to accept or decline the treatment. Skaar interviewed ten older adults a few weeks after TAVI. The patients generally regarded the risk related to the procedure lower than the consequences of living on without replacing the calcified aortic valve. However, some reported to accept the intervention as an obligation to their family.
(2) Skaar and co-workers developed an 8-element frailty score specific to older patients with aortic stenosis. Then, they showed that this 0-9 scoring tool predicted mortality within two years of TAVI in 142 patitents with severe and symptomatic aortic stenosis. 11% died during follow-up, and mortality was 75% higher for each 1 unit increase in frailty score even after adjustment for age, gender and logistic EuroSCORE.
(3) NYHA class had improved significantly six months after TAVI in the 82 patients included in Skaar’s third study. 18% were frail at baseline and the same amount had cognitive impairment or dementia. There was no change in activities of daily living at six months follow-up. Most patients were still alive and lived in their own home two years after TAVI.
(1) Skaar, E., Ranhoff, A. H., Nordrehaug, J. E., Forman, D. E., & Schaufel, M. A. (2017). Conditions for autonomous choice: a qualitative study of older adults’ experience of decision-making in TAVR. Journal of geriatric cardiology: JGC, 14(1), 42
(2) Skaar, E., Eide, L. S. P., Norekvål, T. M., Ranhoff, A. H., Nordrehaug, J. E., Forman, D. E., Schoenenberger, A. V., Hufthammer, K. U., Kuiper, K. K-J., Bleie, Ø., Packer, E. J. S., Langørgen, J., Haaverstad, R., & Schaufel, M. A. (2019). A novel geriatric assessment frailty score predicts 2-year mortality after transcatheter aortic valve implantation. European Heart Journal-Quality of Care and Clinical Outcomes, 5(2), 153-160.
(3) Skaar, E., Øksnes, A., Eide, L. S. P., Norekvål, T. M., Ranhoff, A. H., Nordrehaug, J. E., Forman, D. E., Schoenenberger, A. V., Hufthammer, K. U., Kuiper, K. K-J., Bleie, Ø., Packer, E. J. S., Langørgen, J., Haaverstad, R., & Schaufel, M. A. (2020). Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study. Aging Clinical and Experimental Research, 1-8.