Effect of frailty on in-hospital outcomes after transcatheter mitral valve repair

Abstract

Background Mitral regurgitation (MR) is a common valvular disorder associated with significant morbidity and mortality. Transcatheter mitral valve repair (TMVr) is a minimally invasive procedure indicated for the treatment of selected patients with moderate-severe or severe primary MR. Despite a lack of a universal definition, frailty has been associated with poor post-procedural outcomes. Albeit several trials have examined individual prognostic factors in this population, there is a paucity of data regarding the effect of frailty on in-hospital outcomes after TMVr. Purpose To further elucidate the association of frailty with in-hospital outcomes in patients undergoing TMVr. Methods The national inpatient sample (NIS) database, which is part of the Healthcare Cost and Utilization Project (HCUP), was queried from 2016 to 2019 to identify all who underwent TMVr. International classification of diseases, tenth revision clinical modification (ICD-10-CM) codes were used to divide patients into frail and non-frail study groups. Frailty was defined using Johns Hopkins Adjusted Clinical Groups diagnosis cluster for frailty. Multivariate linear and logistic regression analysis was performed to compare in-hospital mortality, hospital length of stay, non-home discharge, and iatrogenic cardiac complications among Frail and Non-Frail groups. Results A total of 30,660 patients who underwent TMVr were identified. The mean age was 76±11.6 years. Of those, 2,950 (9.6%) were identified as frail. The overall in-hospital mortality rate for the entire study population was 1.89%. Compared to non-frail patients, those identified as frail had greater odds of in-hospital mortality (AOR= 2.13, 95% CI 1.29–3.51, p<0.001) and non-home discharge (AOR= 4.34, 95% CI 3.54–5.32, p<0.001). However, there was no statistically significant difference in hospital length of stay and rates of iatrogenic cardiac complications. Conclusions Frailty models continue to be underutilized as a prognostic tool in clinical practice. After following HCUP guidelines, our analysis found that frailty is independently associated with increased in-hospital mortality and non-home discharge in patients undergoing TMVr. Therefore, we recommend that further efforts in incorporating frailty models in the pre-procedural assessment of patients undergoing TMVr should be sought along with a standardized predictive model for defining frailty. Funding Acknowledgement Type of funding sources: None.

Frailty and transcatheter valve intervention: A narrative review

“…Data regarding frailty in TEER or TMVR are largely based on population cohort studies using frailty scores calculated from hospital administrative data, rather than individual patient assessments. Three large population level cohort studies have used the Johns Hopkins Adjusted Clinical Groups Frailty‐Defining Diagnoses Indicator (ACG) to define frailty 53–55 . Hadaya et al found an independent association between frailty and in‐hospital mortality (adjusted odds ratio [OR]: 1.8, 95% CI: 1.2–2.6; p < 0.001), in‐hospital complications, nonhome discharge, and excessive resource utilization in 18,791 patients undergoing TEER between 2016 and 2018, 11.6% of whom were identified as frail 54 .…”

“…Lopez et al described outcomes from a cohort of 30,660 TEER patients, 9.6% of which was considered frail. Frailty was associated with increased in‐hospital mortality (adjusted OR: 2.1, 95% CI: 1.3–3.5, p < 0.001) and nonhome discharge 55 . Kundi et al used the Hospital Frailty Risk Score (HFRS) to describe outcomes for 3746 patients who underwent TEER in 2016.…”

“…[50][51][52] 3.2 | Mitral transcatheter edge to edge repair Data regarding frailty in TEER or TMVR are largely based on population cohort studies using frailty scores calculated from hospital administrative data, rather than individual patient assessments. Three large population level cohort studies have used the Johns Hopkins Adjusted Clinical Groups Frailty-Defining Diagnoses Indicator (ACG) to define frailty [53][54][55]. found an independent association between frailty and in-hospital mortality (adjusted odds ratio [OR]: 1.8, 95% CI: 1.2-2.6; TEER, primarily the result of a prolonged recovery and increased vulnerability to complications.…”