Habitual Physical Activity in Older Adults Undergoing TAVR

Insights From the FRAILTY-AVR Study

Janarthanan Sathananthan, Sandra Lauck, Nicolo Piazza, Giuseppe Martucci, Dae H. Kim, Jeffrey J. Popma, Anita W. Asgar, Louis P. Perrault, Thierry Lefèvre, Marino Labinaz, Andre Lamy, Mark D. Peterson, Rakesh C. Arora, Nicolas Noiseux, Philippe Genereux, John G. Webb, Jonathan Afilalo

Research output: Contribution to journalArticle

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Abstract

Objectives: The authors sought to assess the distribution and prognostic significance of habitual physical activity (HPA) in older adults undergoing transcatheter aortic valve replacement (TAVR). Background: Low HPA is associated with mortality and disability in community-dwelling older adults. In the setting of TAVR, it is unclear whether low HPA is a risk factor for downstream morbidity or a byproduct of severe aortic stenosis that improves following its correction. Methods: Older adults undergoing TAVR in the prospective multicentre FRAILTY-AVR (Frailty in Aortic Valve Replacement) study were interviewed to quantify their HPA in kilocalories/week using a validated questionnaire at baseline and follow-up. The primary endpoint was all-cause mortality at 12 months. Results: The cohort consisted of 755 patients with a median age of 84.0 years (interquartile range [IQR]: 80.0 to 87.0 years). At baseline, median HPA was 1,116 kcal/week (IQR: 227 to 2,715 kcal/week) with 73% of patients performing <150 min/week of moderate or vigorous HPA. Sedentary patients were more likely to be older, female, frail, cognitively impaired, depressed, and have multimorbidity, although they had similar left ventricular function and aortic stenosis severity. In the logistic regression model adjusting for these covariates, HPA was found to be associated with mortality at 12 months (odds ratio: 0.84/100 kcal; 95% confidence interval: 0.73 to 0.98). HPA was associated with longer length of stay, discharge to health care facilities, and disability. At 12 months, median HPA among survivors was 933 kcal/week (IQR: 0 to 2,334 kcal/week) with pre-existing frailty being independently predictive of worsening HPA following TAVR. Conclusions: Sedentary patients have a higher risk of mortality and functional decline following TAVR.

Original languageEnglish (US)
Pages (from-to)781-789
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume12
Issue number8
DOIs
StatePublished - Apr 22 2019

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Aortic Valve
Exercise
Mortality
Aortic Valve Stenosis
Logistic Models
Transcatheter Aortic Valve Replacement
Independent Living
Health Facilities
Left Ventricular Function
Survivors
Comorbidity
Length of Stay
Odds Ratio
Confidence Intervals
Morbidity
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Sathananthan, J., Lauck, S., Piazza, N., Martucci, G., Kim, D. H., Popma, J. J., ... Afilalo, J. (2019). Habitual Physical Activity in Older Adults Undergoing TAVR: Insights From the FRAILTY-AVR Study. JACC: Cardiovascular Interventions, 12(8), 781-789. https://doi.org/10.1016/j.jcin.2019.02.049
Sathananthan, Janarthanan ; Lauck, Sandra ; Piazza, Nicolo ; Martucci, Giuseppe ; Kim, Dae H. ; Popma, Jeffrey J. ; Asgar, Anita W. ; Perrault, Louis P. ; Lefèvre, Thierry ; Labinaz, Marino ; Lamy, Andre ; Peterson, Mark D. ; Arora, Rakesh C. ; Noiseux, Nicolas ; Genereux, Philippe ; Webb, John G. ; Afilalo, Jonathan. / Habitual Physical Activity in Older Adults Undergoing TAVR : Insights From the FRAILTY-AVR Study. In: JACC: Cardiovascular Interventions. 2019 ; Vol. 12, No. 8. pp. 781-789.
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title = "Habitual Physical Activity in Older Adults Undergoing TAVR: Insights From the FRAILTY-AVR Study",
abstract = "Objectives: The authors sought to assess the distribution and prognostic significance of habitual physical activity (HPA) in older adults undergoing transcatheter aortic valve replacement (TAVR). Background: Low HPA is associated with mortality and disability in community-dwelling older adults. In the setting of TAVR, it is unclear whether low HPA is a risk factor for downstream morbidity or a byproduct of severe aortic stenosis that improves following its correction. Methods: Older adults undergoing TAVR in the prospective multicentre FRAILTY-AVR (Frailty in Aortic Valve Replacement) study were interviewed to quantify their HPA in kilocalories/week using a validated questionnaire at baseline and follow-up. The primary endpoint was all-cause mortality at 12 months. Results: The cohort consisted of 755 patients with a median age of 84.0 years (interquartile range [IQR]: 80.0 to 87.0 years). At baseline, median HPA was 1,116 kcal/week (IQR: 227 to 2,715 kcal/week) with 73{\%} of patients performing <150 min/week of moderate or vigorous HPA. Sedentary patients were more likely to be older, female, frail, cognitively impaired, depressed, and have multimorbidity, although they had similar left ventricular function and aortic stenosis severity. In the logistic regression model adjusting for these covariates, HPA was found to be associated with mortality at 12 months (odds ratio: 0.84/100 kcal; 95{\%} confidence interval: 0.73 to 0.98). HPA was associated with longer length of stay, discharge to health care facilities, and disability. At 12 months, median HPA among survivors was 933 kcal/week (IQR: 0 to 2,334 kcal/week) with pre-existing frailty being independently predictive of worsening HPA following TAVR. Conclusions: Sedentary patients have a higher risk of mortality and functional decline following TAVR.",
author = "Janarthanan Sathananthan and Sandra Lauck and Nicolo Piazza and Giuseppe Martucci and Kim, {Dae H.} and Popma, {Jeffrey J.} and Asgar, {Anita W.} and Perrault, {Louis P.} and Thierry Lef{\`e}vre and Marino Labinaz and Andre Lamy and Peterson, {Mark D.} and Arora, {Rakesh C.} and Nicolas Noiseux and Philippe Genereux and Webb, {John G.} and Jonathan Afilalo",
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Sathananthan, J, Lauck, S, Piazza, N, Martucci, G, Kim, DH, Popma, JJ, Asgar, AW, Perrault, LP, Lefèvre, T, Labinaz, M, Lamy, A, Peterson, MD, Arora, RC, Noiseux, N, Genereux, P, Webb, JG & Afilalo, J 2019, 'Habitual Physical Activity in Older Adults Undergoing TAVR: Insights From the FRAILTY-AVR Study', JACC: Cardiovascular Interventions, vol. 12, no. 8, pp. 781-789. https://doi.org/10.1016/j.jcin.2019.02.049

Habitual Physical Activity in Older Adults Undergoing TAVR : Insights From the FRAILTY-AVR Study. / Sathananthan, Janarthanan; Lauck, Sandra; Piazza, Nicolo; Martucci, Giuseppe; Kim, Dae H.; Popma, Jeffrey J.; Asgar, Anita W.; Perrault, Louis P.; Lefèvre, Thierry; Labinaz, Marino; Lamy, Andre; Peterson, Mark D.; Arora, Rakesh C.; Noiseux, Nicolas; Genereux, Philippe; Webb, John G.; Afilalo, Jonathan.

In: JACC: Cardiovascular Interventions, Vol. 12, No. 8, 22.04.2019, p. 781-789.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Habitual Physical Activity in Older Adults Undergoing TAVR

T2 - Insights From the FRAILTY-AVR Study

AU - Sathananthan, Janarthanan

AU - Lauck, Sandra

AU - Piazza, Nicolo

AU - Martucci, Giuseppe

AU - Kim, Dae H.

AU - Popma, Jeffrey J.

AU - Asgar, Anita W.

AU - Perrault, Louis P.

AU - Lefèvre, Thierry

AU - Labinaz, Marino

AU - Lamy, Andre

AU - Peterson, Mark D.

AU - Arora, Rakesh C.

AU - Noiseux, Nicolas

AU - Genereux, Philippe

AU - Webb, John G.

AU - Afilalo, Jonathan

PY - 2019/4/22

Y1 - 2019/4/22

N2 - Objectives: The authors sought to assess the distribution and prognostic significance of habitual physical activity (HPA) in older adults undergoing transcatheter aortic valve replacement (TAVR). Background: Low HPA is associated with mortality and disability in community-dwelling older adults. In the setting of TAVR, it is unclear whether low HPA is a risk factor for downstream morbidity or a byproduct of severe aortic stenosis that improves following its correction. Methods: Older adults undergoing TAVR in the prospective multicentre FRAILTY-AVR (Frailty in Aortic Valve Replacement) study were interviewed to quantify their HPA in kilocalories/week using a validated questionnaire at baseline and follow-up. The primary endpoint was all-cause mortality at 12 months. Results: The cohort consisted of 755 patients with a median age of 84.0 years (interquartile range [IQR]: 80.0 to 87.0 years). At baseline, median HPA was 1,116 kcal/week (IQR: 227 to 2,715 kcal/week) with 73% of patients performing <150 min/week of moderate or vigorous HPA. Sedentary patients were more likely to be older, female, frail, cognitively impaired, depressed, and have multimorbidity, although they had similar left ventricular function and aortic stenosis severity. In the logistic regression model adjusting for these covariates, HPA was found to be associated with mortality at 12 months (odds ratio: 0.84/100 kcal; 95% confidence interval: 0.73 to 0.98). HPA was associated with longer length of stay, discharge to health care facilities, and disability. At 12 months, median HPA among survivors was 933 kcal/week (IQR: 0 to 2,334 kcal/week) with pre-existing frailty being independently predictive of worsening HPA following TAVR. Conclusions: Sedentary patients have a higher risk of mortality and functional decline following TAVR.

AB - Objectives: The authors sought to assess the distribution and prognostic significance of habitual physical activity (HPA) in older adults undergoing transcatheter aortic valve replacement (TAVR). Background: Low HPA is associated with mortality and disability in community-dwelling older adults. In the setting of TAVR, it is unclear whether low HPA is a risk factor for downstream morbidity or a byproduct of severe aortic stenosis that improves following its correction. Methods: Older adults undergoing TAVR in the prospective multicentre FRAILTY-AVR (Frailty in Aortic Valve Replacement) study were interviewed to quantify their HPA in kilocalories/week using a validated questionnaire at baseline and follow-up. The primary endpoint was all-cause mortality at 12 months. Results: The cohort consisted of 755 patients with a median age of 84.0 years (interquartile range [IQR]: 80.0 to 87.0 years). At baseline, median HPA was 1,116 kcal/week (IQR: 227 to 2,715 kcal/week) with 73% of patients performing <150 min/week of moderate or vigorous HPA. Sedentary patients were more likely to be older, female, frail, cognitively impaired, depressed, and have multimorbidity, although they had similar left ventricular function and aortic stenosis severity. In the logistic regression model adjusting for these covariates, HPA was found to be associated with mortality at 12 months (odds ratio: 0.84/100 kcal; 95% confidence interval: 0.73 to 0.98). HPA was associated with longer length of stay, discharge to health care facilities, and disability. At 12 months, median HPA among survivors was 933 kcal/week (IQR: 0 to 2,334 kcal/week) with pre-existing frailty being independently predictive of worsening HPA following TAVR. Conclusions: Sedentary patients have a higher risk of mortality and functional decline following TAVR.

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