The value of screening for cognition, depression, and frailty in patients referred for TAVI

Maisha M Khan,1,2 Krista L Lanctôt,1–3 Stephen E Fremes,4 Harindra C Wijeysundera,4 Sam Radhakrishnan,4 Damien Gallagher,3 Dov Gandell,5 Megan C Brenkel,1 Elias L Hazan,1 Natalia G Docteur,1 Nathan Herrmann1,31Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; 2Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; 3Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada; 4Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 5Department of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, CanadaBackground: Current surgical risk assessment tools fall short of appreciating geriatric risk factors including cognitive deficits, depressive, and frailty symptoms that may worsen outcomes post-transcatheter aortic valve implantation (TAVI). This study hypothesized that a screening tool, SMARTIE, would improve detection of these risks pre-TAVI, and thus be predictive of postoperative delirium (POD) and 30-day mortality post-TAVI.Design: Prospective observational cohort study, using a historical cohort for comparison.Participants: A total of 234 patients (age: 82.2±6.7 years, 59.4% male) were included. Half were screened using SMARTIE.Methods: The SMARTIE cohort was assessed for cognitive deficits and depressive symptoms using the Mini-Cog test and PHQ-2, respectively. Measures of frailty included activities of daily living inventory, the Timed Up and Go test and grip strength. For the pre-SMARTIE cohort, we extracted cognitive deficits, depression and frailty symptoms from clinic charts. The incidence of POD and 30-day mortality were recorded. Bivariate chi-square analysis or t-tests were used to report associations between SMARTIE and pre-SMARTIE groups. Multivariable logistic regression models were employed to identify independent predictors of POD and 30-day mortality.Results: More patients were identified with cognitive deficits (χ2=11.73, p=0.001), depressive symptoms (χ2=8.15, p=0.004), and physical frailty (χ2=5.73, p=0.017) using SMARTIE. Cognitive deficits were an independent predictor of POD (OR: 8.4, p<0.01) and 30-day mortality (OR: 4.04, p=0.03).Conclusion: This study emphasized the value of screening for geriatric risk factors prior to TAVI by demonstrating that screening increased identification of at-risk patients. It also confirmed findings that cognitive deficits are predictive of POD and mortality following TAVI.Keywords: TAVI, cognition, depression, frailt