Abstract
INTRODUCTION: The number of transcatheter aortic valve implantations (TAVIs) performed in the UK is increasing exponentially, providing a new treatment avenue for patients with severe symptomatic aortic stenosis previously deemed too frail for surgical intervention. Frailty is known to be associated with poor outcomes following TAVI, however little is known as to whether comprehensive geriatric assessment (CGA), the gold standard intervention for older adults in a range of clinical settings, can change outcomes for older adults undergoing this procedure.
METHODS: Databases EMBASE, MEDLINE, CINAHL and Cochrane CENTRAL, along with the World Health Organisation clinical trials registry platform and Clinicaltrials.gov registry were searched for relevant reports between 01/01/1980 - 26/01/2022 using a pre-specified search strategy. Patients had to be 65 or over and studies had to evaluate single- or multi-domain interventions that may form part of a CGA. Studies were not limited to those only looking at patients living with or at risk of frailty.
RESULTS: No studies of adequate quality evaluated the effect of CGA on outcomes for older adults undergoing TAVI. 18 studies evaluating CGA-related interventions were identified that met eligibility criteria, with the majority evaluating cardiac rehabilitation (CR) as a post-procedural intervention. Other interventions evaluated included cognitive behavioural therapy, alternative exercise-based interventions and post-procedural protocols that promoted early mobilisation and allied health professional involvement. A high risk of bias and significant methodological flaws were found in the included studies. There was very low quality evidence that post-procedural CR reduces mortality and to support the role of occupational and physical therapy for improving in-hospital outcomes for these patients.
CONCLUSION(S): There is no convincing evidence to support CGA or related single domain interventions to improve outcomes for older adults undergoing TAVI. Further robust research is required to establish whether CGA improves outcomes for this group.