A Geriatric Assessment Score Predicting 1-Year Mortality and Functional Decline After TAVR

BACKGROUND: A significant proportion of older adults undergoing transcatheter aortic valve replacement (TAVR) fail to achieve meaningful clinical benefit at 1 year, highlighting the need for improved risk stratification. OBJECTIVES: The aim of this study was to develop and validate a geriatric score to determine 1-year mortality or functional decline. METHODS: A multicenter cohort study was conducted across 3 high-volume academic centers in Italy from January 2020 to December 2022. Consecutive patients ≥75 years of age with severe symptomatic aortic stenosis evaluated for TAVR were enrolled. Participants underwent a comprehensive geriatric assessment, including basic activities of daily living (BADL) and the Mini Nutritional Assessment-Short Form. The Society of Thoracic Surgeons score was also collected. The primary outcome was a composite of all-cause mortality or significant functional decline (loss of ≥2 BADL or failure to improve if already impaired) at 1 year. A logistic regression model identified predictive factors, and a new risk score was derived in a 66% derivation cohort and tested in a 34% validation cohort. RESULTS: Among 562 patients (median age 83 years, 58.5% women), 78 (13.9%) met the primary outcome over 11 months (Q1-Q3: 10-12 months). Mini Nutritional Assessment-Short Form score, BADL, lower estimated glomerular filtration rate, and elevated pulmonary artery systolic pressure were independently associated with the composite outcome. The derived score showed high discrimination (area under the curve, 0.92; 95% CI: 0.88-0.96). In validation, performance remained robust (area under the curve, 0.87; 95% CI: 0.79-0.95), outperforming the Society of Thoracic Surgeons score. CONCLUSIONS: A geriatric assessment-based model significantly improved the prediction of 1-year mortality or functional decline in older TAVR candidates, offering a valuable tool to refine patient selection and avoid procedural futility.