A high mortality rate is expected in untreated aortic stenosis (AS) patients when symptoms in form of angina, syncope and heart failure develop. Surgical aortic valve replacement (SAVR) is the gold standard surgical treatment for AS. Yet, its operative risk might be too high in elderly patients with coexisting conditions. Transcatheter aortic valve implantation (TAVI) is an option for patients without reasonable surgical alternatives. Many patients undergoing TAVI are 80 years and older.
Old patients undergoing cardiac surgery often develop postoperative delirium (PD), an acute state of confusion characterized by temporarily and fluctuating decline in attention and cognition. Knowledge about octogenarians undergoing invasive cardiovascular therapy is scarce, and PD after TAVI remains to be explored.
Therefore, the aims of this study were to
- i) identify incidence, risk factors and possible differences in the course and onset of postoperative delirium in octogenarians accepted for SAVR or TAVI
- ii) determine how delirium can predict activities of daily living (ADL), instrumental activities of daily living (IADL), cognitive function and self-reported health status, and
- iii) investigate if the absence of delirium, can predict readmissions and mortality
CARDELIR is a prospective cohort study of patients with AS accepted for TAVI or SAVR. Inclusion criteria: age 80+ and previous acceptance for TAVI or SAVR. Exclusion criteria: inability to speak Norwegian and denied consent to join the study. Baseline data was collected the day before treatment, and follow-up was done one and six months later. The incidence of PD was measured for five postoperative days with the Confusion Assessment Method (CAM). Barthel Index and Nottingham Extended Activities of Daily Living Scale were used to study ADL and IADL. Cognitive function was measured with the Mini Mental State Examination (MMSE) and self-reported health status with SF-12.
- Amofah HA, Broström A, Fridlund B, Bjorvatn B, Haaverstad R, Hufthammer KO, Kuiper KK, Ranhoff AH, Norekvål TM; CARDELIR Investigators.Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement.
Eur J Cardiovasc Nurs. 2016 Apr;15(2):168-77. doi: 10.1177/1474515115620992. Epub 2015 Dec 3.
- Olsen SJ, Fridlund B, Eide LS, Hufthammer KO, Kuiper KK, Nordrehaug JE, Skaar E, Norekvål TM; CARDELIR Investigators.
Changes in self-reported health and quality of life in octogenarian patients one month after transcatheter aortic valve implantation.
Eur J Cardiovasc Nurs. 2016 Apr 1. pii: 1474515116641297.
- Eide LSP, Ranhoff AH, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KK, Nordrehaug JE, Norekvål TM. CARDELIR Investigators.
Delirium as a Predictor of Physical and Cognitive Function in Individuals Aged 80 and Older After Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement. J Am Geriatr Soc. 2016 Jun;64(6):1178-86. doi: 10.1111/jgs.14165. Epub 2016 Apr 23
- Eide LSP, Ranhoff AH, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KJ, Nordrehaug JE, Norekvål TM. Comparison of Frequency, Risk Factors and time course of postoperative delirium in octogenarians after transcatheter aortic valve implantation versus surgical aortic valve replacement. American Journal of Cardiology. 2015