Key result
Geriatric assessment score predicts 1-year mortality and functional decline after TAVR.
Why the study?
A significant proportion of older adults undergoing TAVR fail to achieve meaningful clinical benefit at 1 year, highlighting the need for improved risk stratification.
Does a novel geriatric assessment score improve the prediction of 1-year mortality or functional decline compared to the STS score in older adults undergoing TAVR?
Cohort (n=562)
Yes
Does a novel geriatric assessment score improve the prediction of 1-year mortality or functional decline compared to the STS score in older adults undergoing TAVR?
Effect estimate: AUC 0.87 (95% CI 0.79-0.95)
A novel geriatric assessment score accurately predicts 1-year mortality or functional decline in older TAVR candidates, outperforming the traditional STS score and aiding in the avoidance of procedural futility.
BACKGROUND: A significant proportion of older adults undergoing transcatheter aortic valve replacement (TAVR) fail to achieve meaningful clinical benefit at 1 year, highlighting the need for improved risk stratification. OBJECTIVES: The aim of this study was to develop and validate a geriatric score to determine 1-year mortality or functional decline. METHODS: A multicenter cohort study was conducted across 3 high-volume academic centers in Italy from January 2020 to December 2022. Consecutive patients ≥75 years of age with severe symptomatic aortic stenosis evaluated for TAVR were enrolled. Participants underwent a comprehensive geriatric assessment, including basic activities of daily living (BADL) and the Mini Nutritional Assessment-Short Form. The Society of Thoracic Surgeons score was also collected. The primary outcome was a composite of all-cause mortality or significant functional decline (loss of ≥2 BADL or failure to improve if already impaired) at 1 year. A logistic regression model identified predictive factors, and a new risk score was derived in a 66% derivation cohort and tested in a 34% validation cohort. RESULTS: Among 562 patients (median age 83 years, 58.5% women), 78 (13.9%) met the primary outcome over 11 months (Q1-Q3: 10-12 months). Mini Nutritional Assessment-Short Form score, BADL, lower estimated glomerular filtration rate, and elevated pulmonary artery systolic pressure were independently associated with the composite outcome. The derived score showed high discrimination (area under the curve, 0.92; 95% CI: 0.88-0.96). In validation, performance remained robust (area under the curve, 0.87; 95% CI: 0.79-0.95), outperforming the Society of Thoracic Surgeons score. CONCLUSIONS: A geriatric assessment-based model significantly improved the prediction of 1-year mortality or functional decline in older TAVR candidates, offering a valuable tool to refine patient selection and avoid procedural futility.
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Fumagalli et al. (2026) conducted a cohort in severe symptomatic aortic stenosis (n=562). Geriatric assessment-based risk score vs. Society of Thoracic Surgeons score was evaluated on Composite of all-cause mortality or significant functional decline (loss of ≥2 BADL or failure to improve if already impaired) at 1 year (AUC 0.87, 95% CI 0.79-0.95). A geriatric assessment-based model accurately predicted 1-year mortality or functional decline in older TAVR candidates, outperforming the STS score (validation AUC 0.87; 95% CI 0.79-0.95).
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