Author + information
- Received October 17, 2018
- Revision received January 22, 2019
- Accepted February 11, 2019
- Published online April 15, 2019.
- Janarthanan Sathananthan, MBChB, MPHa,
- Sandra Lauck, PhDa,
- Nicolo Piazza, MD, PhDb,
- Giuseppe Martucci, MDb,
- Dae H. Kim, MD, ScDc,
- Jeffrey J. Popma, MDc,
- Anita W. Asgar, MD, MScd,
- Louis P. Perrault, MD, PhDd,
- Thierry Lefèvre, MDe,
- Marino Labinaz, MDf,
- Andre Lamy, MDg,
- Mark D. Peterson, MD, PhDh,
- Rakesh C. Arora, MD, PhDi,
- Nicolas Noiseux, MD, MScj,
- Philippe Généreux, MDk,
- John G. Webb, MDa and
- Jonathan Afilalo, MD, MScl,∗ ()
- aCentre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, University of British Columbia, Vancouver, British Columbia, Canada
- bMcGill University Health Centre, Montreal, Quebec, Canada
- cBeth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
- dInstitut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
- eInstitut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
- fUniversity of Ottawa Heart Institute, Ottawa, Ontario, Canada
- gHamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- hSt. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- iSt. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
- jCentre Hospitalier de l’Université de Montréal, Centre de Recherche du CHUM, Montreal, Quebec, Canada
- kMorristown Medical Center, Morristown, New Jersey
- lJewish General Hospital, McGill University, Montreal, Quebec, Canada
- ↵∗Address for correspondence:
Dr. Jonathan Afilalo, Divisions of Cardiology & Clinical Epidemiology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, E-222, Montreal, Quebec H3T 1E2, Canada.
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.
- aortic stenosis
- habitual physical exercise capacity
- transcatheter aortic valve replacement
Dr. Sathananthan has received speaking fees from Edwards Lifesciences. Dr. Lauck has been a consultant to Edwards Lifesciences. Dr. Piazza has been a consultant to Highlife, Microport, Boston Scientific, and Medtronic; and a proctor for Microport and Medtronic. Dr. Martucci has been a consultant to Boston Scientific; and proctor for Boston Scientific and Medtronic. Dr. Kim has been a consultant to Alosa Health. Dr. Popma has received institutional grants from Medtronic, Boston Scientific, Abbott Vascular, and Edwards Lifesciences; and has served on medical advisory boards for Boston Scientific and Edwards Lifesciences. Dr. Asgar has been a consultant to Edwards Lifesciences and Medtronic; and has been a proctor for and served on an advisory board for Medtronic. Dr. Perrault has been a consultant to Somahlution; and served on an advisory board for Clearflow. Dr. Lefèvre has served on a proctor for Edwards Lifesciences and Abbott Vascular; has received minor fees from Medtronic. Dr. Peterson has served on a proctor for Edwards Lifesciences and LivaNova. Dr. Arora has received an unrestricted educational grant from Pfizer; has served on an advisory board for CSU-ALS North America; and has received honoraria from Mallinckrodt Pharmaceuticals. Dr. Généreux has served as a proctor for Edwards Lifesciences; and has received speaker fees from Edwards Lifesciences and Medtronic. Dr. Webb has been a consultant to Edwards Lifesciences and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 17, 2018.
- Revision received January 22, 2019.
- Accepted February 11, 2019.
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