Aims
To evaluate the impact of age on mortality and functional outcomes following TAVI in a contemporary Victorian cohort of older adults.
Methods
This retrospective cohort study analysed data from a metropolitan hospital database from 2019–2024. TAVI patients were stratified into: <75 years, 75–84 years, ≥85 years. Demographics included Clinical Frailty Scale (CFS).
Primary end point was mortality at 30-days and at 12-months. Secondary end points: transition to supported care, quality of life measures using Kansas City Cardiomyopathy Questionnaire (KCCQ) and EQ-5D at 30-days and 12-months. Multivariable regression models adjusted for sex, pre-event living status, diabetes and smoking status. Associations were expressed per 5-year increase in age.
Results
803 patients underwent TAVI. 12-month mortality was low (1.5%, n=12) and wasn't independently associated with increasing age (adjusted OR 1.40, 95% CI 0.88–2.22). Increasing age was associated with higher baseline CFS (adjusted OR 1.44 per 5-year increase, 95% CI 1.31–1.59). Higher CFS were associated with increased odds of mortality, although small events and loss to follow-up limited validity.
Each 5-year increase in age was associated with greater odds of transition to supported care at 30-days (adjusted OR 2.29, 95% CI 1.52–3.47) and 12-months (adjusted OR 2.17, 95% CI 1.51–3.14). KCCQ improved across all ages, without statistically significant attenuation in the older group. Age was not associated with EQ-5D.
Conclusions
Chronological age alone wasn't associated with mortality after TAVI but was linked to greater frailty and increased transition to supported care. These findings support incorporating comprehensive geriatric and frailty assessment into preoperative evaluation rather than relying on age alone.