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February 4, 2019

Invasive Procedures to Improve Function in Frail Older Adults: Do Outcomes Justify the Intervention?

Author Affiliations
  • 1Department of Surgery, University of California, San Francisco
JAMA Intern Med. 2019;179(3):391-393. doi:10.1001/jamainternmed.2018.6708

Severe aortic stenosis (AS) causes symptoms that significantly limit activity and impair quality of life in older adults. Mortality for patients with severe AS who are not surgical candidates and who undergo medical management is as high as 50% at 1 year,1 driving the pursuit of therapeutic interventions in this high-risk group. Over the past 15 years, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR) for severe AS and is increasingly being used in older patients with a high burden of comorbidity. Severe AS has a prevalence of 3.4% in patients 75 years and older, and it is estimated that there are more than 100 000 high-risk and 50 000 intermediate-risk TAVR candidates in this age group in North America.2 This number will continue to increase as our population ages. With the large number of older patients with severe AS who may be considered for TAVR, it is necessary to understand the expected outcomes that matter to older adults, including postoperative functional status.

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