Validated web-based tools to identify potential barriers to recovery and rehabilitation following TAVI

Introduction: Prevalence of aortic stenosis and comorbidity burden correlates with advancing age. The Charlson Comorbidity Index (CCI) is a widely validated tool that predicts outcomes in a range of conditions and settings.

Methods: We analysed 38 eligible patients referred for CT TAVI at our institution between August 21 - December 22 and calculated their CCI score to study its impact on symptoms, procedural complications and mortality at 30-days, 6-months and 1-year post TAVI. Evidence of frailty screening was determined using retrospective case note review.

Results: Thirty-eight patients were referred for TAVI with mean age 77.9 and mean CCI 4.5. Twenty-seven (71%) underwent TAVI with mean age 77.5 and mean CCI 5.2. The commonest comorbidities were myocardial infarction (47%), congestive heart failure (21%) and COPD (34%). At 30-days, 41% of patients (mean CCI 4.3) had objective improvement in exercise tolerance, 33% (mean CCI 5) reported subjective improvement and 7% (mean CCI 7) experienced no change in symptoms. Complications occurred in 2 (mean CCI 4.5). The benefit persisted in 15 out of 18 at 6 months. At 1-year, 3 out of 6 reported sustained benefit (mean CCI 4.6) and 3 reported worsening symptoms (mean CCI 5.6) due to progression of mitral valve disease (1), new diagnosis of possible cancer (1) and worsening ankle swelling (1). Frailty screening was not routinely done.

Conclusion: The CCI tool is reliable in predicting TAVI outcomes. Good 30-day outcomes were seen with CCI ≤5 but benefit decreased at 6-months and 1-year when CCI >5.6, reflecting European Society of Cardiology guidance of CCI >5 conferring poorer prognosis. Futility was predicted by CCI >7 in our group. The Rockwood Clinical Frailty scale identifies mild-moderate frailty (CFS 5/6), in whom comprehensive geriatric assessment can help. These rapid web-based tools can be performed in clinic to identify potential barriers to recovery.