Functional Outcomes After Cardiac Procedures
Older adults have a high burden of heart disease that often requires surgical procedures to improve symptoms and functioning. However, many older adults also have multiple non-cardiac chronic conditions and pre-existing functional limitations that may get worse due to the stress from invasive surgical procedures and hospitalization. This “trade-off” presents a unique challenge to patients and clinicians in considering cardiac surgical procedures at advanced age.
Our program aims to help patients and clinicians navigate this complex process through research and clinical consultation. We have been tracking health status of older adults who underwent transcatheter aortic valve replacement or surgical aortic valve replacement to improve our understanding of functional status change after these procedures; researching preoperative predictors of unfavorable outcomes; and testing home-based rehabilitation programs to facility recovery after transcatheter aortic valve replacement. From what we learn from these ongoing research studies, we provide comprehensive geriatric evaluation to patients with multimorbidity and frailty who are considering cardiac surgical procedures for their advanced heart condition.
Shi S, Afilalo J, Lipsitz LA, Popma JJ, Khabbaz KR, Laham RJ, Guibone K, Grodstein F, Lux E, Kim DH. "Frailty Phenotype and Deficit Accumulation Frailty Index in Predicting Recovery After Transcatheter and Surgical Aortic Valve Replacement." J Gerontol A Biol Sci Med Sci. 2018 Aug 25. PMID: 30165422.
Afilalo J, Lauck S, Kim DH, Lefèvre T, Piazza N, Lachapelle K, Martucci G, Lamy A, Labinaz M, Peterson MD, Arora RC, Noiseux N, Rassi A, Palacios IF, Généreux P, Lindman BR, Asgar AW, Kim CA, Trnkus A, Morais JA, Langlois Y, Rudski LG, Morin JF, Popma JJ, Webb JG, Perrault LP. "Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study." J Am Coll Cardiol. 2017 Aug 08; 70(6):689-700. PMID: 28693934.
Kim DH, Kim CA, Placide S, Lipsitz LA, Marcantonio ER. "Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures: A Systematic Review." Ann Intern Med. 2016 Nov 01; 165(9):650-660. PMID: 27548070.
Kim CA, Rasania SP, Afilalo J, Popma JJ, Lipsitz LA, Kim DH. "Functional status and quality of life after transcatheter aortic valve replacement: a systematic review." Ann Intern Med. 2014 Feb 18; 160(4):243-54. PMID: 24727842; PMCID: PMC4039034.
Dae Kim, MD, MPH, ScD, Assistant Professor of Medicine, Harvard Medical School, Geriatrician
Sandra Shi, MD, Geriatrics fellow