Patient-reported functional and symptomatic outcomes in patients with mild cognitive disorder undergoing transcatheter aortic valve implantation - A secondary analysis of a randomized controlled trial
Bibliographic record
Abstract
Abstract Background The impact of pre-existing mild cognitive disorder (MCD) on patient-reported outcome measures (PROMs) after transcatheter aortic valve implantation (TAVI) remains unclear. Purpose To investigate functional and symptomatic outcomes after TAVI in patients with or without MCD at two German tertiary care centers as part of a randomised controlled trial (TAVI-COMIC study). Methods Adult patients undergoing elective TAVI were enrolled. MCD was defined by the Montreal Cognitive Assessment (MoCA) <26 points. PROMs were assessed at 90 days after TAVI. Results Of 199 patients, 109 (54.8%) showed MCD. Female patients had significantly more often MCD (49.5% vs. 34.4%, p=0.046). Prior to TAVI, 21.6% reported dyspnea (NYHA class III-IV), 35.1% angina (CCS class II-IV), 41.2% dizziness and 12.6% syncope. Both patient groups reported similar improvements in general health status after TAVI: "marginally or significantly better" health status in 73.5% with MCD vs. 68.9% without MCD (p=n.s.). In multivariable logistic regression models, the number of patients reporting a "good, very good or excellent" general health status after TAVI was similar in both patient groups (p=n.s.) (Table). Similarly, post-TAVI symptoms of dyspnea, angina, dizziness or syncope were similar between both groups (each p=n.s.). Procuration and walking ability without difficulties as well as functional independence were 54% [95% Confidence Interval (CI) 0.23-0.92] (p=0.028), 55% [95% CI 0.22-0.89] (p=0.023) and 52% [95% CI 0.24-0.94] (p=0.035) less frequently reported by patients with MCD compared to patients without MCD, respectively. Of note, delirium was more frequently observed in patients with MCD within 3 days after TAVI (8.3% vs. 1.1%, p=0.049). Conclusions TAVI appeared to result in similar improvements in general health status and symptomatic PROMs in patients with and without MCD. Though, patients with MCD reported impaired functional PROMs after TAVI. More careful post-procedural care should be taken for patients with MCD to enhance functional independence in this vulnerable patient group.
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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 | 0.008 | 0.012 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.006 | 0.008 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".