ABSTRACT
INTRODUCTION: Certain frail patients fail to achieve adequate functional or mortality benefit despite successful transcatheter aortic valve replacement (TAVR). Therefore, frailty assessment methods are becoming an important tool to identify and intervene on this high-risk patient subset for improving clinical outcomes. Areas covered: The authors provide an overview of frailty and frailty assessment tools being used in clinical practice and discuss the impact of frailty on the cardiac patients, particularly among the TAVR population. Expert commentary: Available evidence suggests that frailty assessment is critical for identifying patients at high risk of morbidity and mortality after TAVR procedures. However, there is lack of consensus for the best methodology to determine frailty and its optimal management in TAVR populations. Although, physical exercise is a commonly employed intervention to reduce frailty, a greater attention towards improving nutrition may convey more benefit than either intervention alone. Ongoing studies are investigating the benefits of a multicomponent approach to improve clinical outcomes in frail patients undergoing TAVR.
Subject(s)
Aortic Valve Stenosis/surgery , Frailty/diagnosis , Transcatheter Aortic Valve Replacement , Aged , Aged, 80 and over , Aortic Valve Stenosis/complications , Female , Frail Elderly , Frailty/complications , Heart Valve Prosthesis , Humans , Male , Risk Factors , Treatment OutcomeABSTRACT
PURPOSE: To describe the provision of weekend physiotherapy (PT) services in tertiary-care hospitals in Canada. METHODS: A prospective cross-sectional survey was conducted across tertiary-care hospitals, defined as those with university affiliation and at least one intensive care unit (ICU). Data were collected via telephone-administered questionnaires addressing hospital demographics, weekend staffing, workload, and weekend referral criteria. RESULTS: A response rate of 84% (n=36) was obtained. Of facilities providing weekend PT services (97%), 35 (100%) provided care on Saturdays, 32 (91%) on Sundays, and 33 (94%) on statutory holidays. Weekend services were staffed using permanent full-time (n=35; 100%) or part-time (n=28; 80%) in-patient staff or outsourced staff (n=1; 3%). The number of physiotherapists available on the weekend was smaller than the number available during the week (p<0.001). Common weekend referral criteria included cardiorespiratory problems (n=35; 100%), postoperative assessment of patients at risk for deterioration (n=32; 91%), and patients scheduled for discharge pending PT assessment (n=30; 86%). CONCLUSION: Both the scope and the number of staff available to provide PT services were less on the weekend than during the week. Despite the use of common criteria for weekend referral, variability in this service exists. Knowledge pertaining to current weekend PT services provides opportunities for harmonization of service delivery.
