Abstract 17277: Holistic Health-Related Quality of Life in Older Adults Undergoing Transcatheter Aortic Valve Replacement
Bibliographic record
Abstract
Introduction: Health-related quality of life (HRQoL) is a prioritized outcome for older adults undergoing transcatheter aortic valve replacement (TAVR). Previous studies have used the Kansas City Cardiomyopathy Questionnaire (KCCQ) to evaluate HRQoL, which is heavily weighted on heart failure symptoms with only one question on mental wellbeing. We sought to determine the incidence and determinants of poor HRQoL using a novel holistic scale. Methods: The FRAILTY-AVR prospective multi-centre cohort study of older adults undergoing TAVR was used to develop a holistic HRQoL scale. Construct validity was evaluated using the Spearman’s rank correlation with the 12-item KCCQ, and clinically meaningful change was evaluated using the anchor-based method. The primary endpoint was “poor outcome” defined as all-cause mortality or clinically meaningful decrease in HRQoL at 1 year. Results: The cohort consisted of 693 patients with a mean age of 82.9 years and 47% females. A 23-item HRQoL scale was developed, with the total score ranging from 0 (worst) to 40 (best) across 5 domains: disease burden (3 items), general health (1 item), physical (6 items), mental (5 items), and social (8 items) functioning. This scale was correlated with the KCCQ (Spearman’s rho 0.56, P<0.0001) and a 3-unit change was found to be clinically meaningful in longitudinal follow-up. A total of 269 (39%) patients experienced a poor outcome at 1 year post-TAVR, including 144 (21%) deaths. The predictors of poor outcome were Essential Frailty Toolset score >=3 [OR 1.88; 95% CI 1.28, 2.76], mean aortic gradient <40 mmHg [OR 1.83; 95% CI 1.27, 2.63] and Charlson comorbidity index [OR 1.09; 95% CI 1.01, 1.18]. Conclusions: Two of five patients had a poor outcome 1 year post-TAVR, despite a procedure success rate of 95%. The incidence and determinants of poor outcome using our holistic HRQoL scale, notably the impact of frailty, are highly consistent with previous studies using the KCCQ. These determinants should be integrated in patient-centered decision making and optimized to improve HRQoL post-procedure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".