{"id":138325,"date":"2024-04-09T18:06:35","date_gmt":"2024-04-09T22:06:35","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138325"},"modified":"2024-04-09T18:06:35","modified_gmt":"2024-04-09T22:06:35","slug":"perform-tavr-home-based-exercise-and-protein-supplementation-improves-physical-performance-in-frail-adults-post-tavr","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138325","title":{"rendered":"PERFORM-TAVR: Home based exercise and protein supplementation improves physical performance in frail adults post-TAVR"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Key Points:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Many frail patients experience poor physical performance after TAVR, even when the procedure is a technical success.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In frail, older patients undergoing TAVR, a combined program of home based exercise and protein supplementation 4 weeks before and 12 weeks after the procedure significantly improved standardized physical performance scores compared to a control of lifestyle education.<\/span><\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">Prior prospective cohort studies have found that frailty is a powerful predictor of poor outcomes and physical decline following transcatheter aortic valve replacement (TAVR).\u00a0 Whether periprocedural interventions meant to counteract frailty can improve outcomes is unknown.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">On April 8, 2024, the principal results of the \u201cProtein and Exercise to Reverse Frailty in Older Men and Women Undergoing TAVR: The PERFORM-TAVR Trial\u201d were presented at ACC Scientific Sessions 2024.\u00a0 The purpose of this study was to test whether an exercise- and diet-based anti-frailty intervention could improve functional outcomes following TAVR.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Patients aged 70 or older with objective evidence of physical frailty by validated scores were randomized to an intervention of lifestyle education, protein rich oral nutrition supplementations, and a partially supervised homebased exercise program or a control of lifestyle education alone. Those with advanced NYHA Class IV symptoms, cirrhosis, significant CKD, inability to walk without assistance, more than 2 falls in the past year, significant language barrier, or moderate to severe cognitive impairment were excluded.\u00a0 The primary outcome was the Short Physical Performance Battery (SPPB ) score as measured by blinded assessors at 12 weeks.\u00a0 A modified intention to treat analysis using regression adjusted for baseline score, age, sex, BMI, and study center was performed.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A total of 180 patients were included in the primary analysis.\u00a0 More than 70% were older than 80 and 45% were female. They completed a mean of 22 exercise sessions.\u00a0 The mean baseline SBBP score was 7.1 in both the intervention and control group, and increased to 8.1 for the intervention group at 12 weeks, but remained 7.1 for the control group.\u00a0 After multivariable adjustment and using multiple imputation for missing data, this represented a significant improvement (+0.9 points, [95% CI 0.3-1.6], p=0.006).\u00a0 The gain of 1 point on this scale is considered a clinically meaningful change, as it correlated with a 14% reduction in death or readmission for patients with heart failure and an increase of 16 meters in 6 minute walk distance. <\/span><span style=\"font-weight: 400;\">Limitations include COVID related interruptions to the study protocol and a 14% missing rate due to early drop out or the competing risk of mortality.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Dr. Jonathan Afilalo, MD of McGill University, concluded: \u201cA home-based exercise intervention with protein supplementation was safe\u00a0 and improved physical performance at 12 weeks in frail TAVR patients.\u00a0 Despite high technical success and low procedural complications, TAVR alone did not improve physical performance metrics of strength, mobility, and balance.\u00a0 This trial supports a shift towards a more holistic treatment paradigm that addresses frailty to optimize functioning and quality of life following TAVR.\u201d<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: Many frail patients experience poor physical performance after TAVR, even when the procedure is a technical success.\u00a0 In frail, older patients undergoing TAVR, a combined program of home based exercise and protein supplementation 4 weeks before and 12 weeks after the procedure significantly improved standardized physical performance scores compared to a control of [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":138326,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[888],"tags":[889,45,47,185],"ppma_author":[1029],"class_list":{"0":"post-138325","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-acc-2024","8":"tag-acc-2024","9":"tag-conference","10":"tag-featured","11":"tag-news","12":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138325"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138325\/revisions"}],"predecessor-version":[{"id":138327,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138325\/revisions\/138327"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138326"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138325"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138325"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138325"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}