The edition · Geriatrics
After TAVI, dapagliflozin's apparent benefit concentrated in frail patients in a post hoc DapaTAVI analysis
Among 1222 patients, nearly half were frail, and the hazard of death or worsening heart failure was about halved with dapagliflozin in that group but not in others. Also: VES-13 as a screen in older people with cancer, unrecognised hearing loss and carer depression, and resistance training for thinking skills.
The edition in brief
Today's geriatrics edition leads on frailty after transcatheter aortic valve implantation. A post hoc analysis of the DapaTAVI trial in JAHA classified 1222 patients by the FRAIL scale: 47.2% frail, 40.3% prefrail, 12.4% robust. Frailty was independently associated with death or worsening heart failure at one year (adjusted HR 2.29 versus robust). Dapagliflozin was associated with a lower hazard in frail patients (HR 0.53, 95% CI 0.36 to 0.77) but not in prefrail or robust patients (interaction P = 0.021), with no difference in safety by frailty. A JAMDA meta-analysis of 36 studies (7110 patients) found the Vulnerable Elders Survey-13 had moderate accuracy for identifying abnormalities on comprehensive geriatric assessment and that high scores predicted worse overall survival (HR 1.68) and more adverse events in older people with cancer. A US national survey of 1480 caregivers found those caring for someone with unrecognised hearing loss were more likely to report depressive symptoms (OR about 2). A meta-analysis of 17 trials found resistance training modestly improved working memory and cognitive flexibility in older adults, with low certainty. The pearl covers lying and standing blood pressure after a fall.
VES-13 flags older people with cancer who need full geriatric assessment
Screen older people with cancer with VES-13 and send positive screens for full geriatric assessment before treatment.
Carers of people with unrecognised hearing loss reported more depressive symptoms
Check hearing objectively in older patients and ask how their carers are coping.
Resistance training modestly improved working memory and cognitive flexibility in older adults
Prescribe strength training to older adults for muscle and falls; any cognitive benefit is a modest bonus.
After a fall, measure lying and standing blood pressure
Check lying and standing blood pressure after every fall in an older patient, and review the drug list.
Dapagliflozin after TAVI: the frail half of patients showed the benefit
Consider dapagliflozin after TAVI in frail older patients rather than withholding it because of frailty.
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