Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort

Kundi, Harun; Popma, Jeffrey J.; Reynolds, Matthew R.; Strom, Jordan B.; Pinto, Duane S.; Valsdottir, Linda R.; Shen, Changyu; Choi, Eun Hee; Yeh, Robert W.

doi:10.1093/eurheartj/ehz187

Cited by 86 publications

(62 citation statements)

References 31 publications

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“…Thus, the notion of frailty as a determinant of an increased vulnerability comes back to the center of the debate, especially for its eligibility as a predictor of adverse outcomes in older patients with COVID-19 4 , 5 . Although frailty has shown to be a reliable predictor of clinical and healthcare-related outcomes in various conditions 6 , 7 , the outcomes of frail older patients diagnosed with COVID-19 remain unclear and arguable 8 , 9 , 10 , 11 , 12 , 13 .…”

Section: Introductionmentioning

confidence: 99%

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

Kundi

Çetin

Canpolat

et al. 2020

Journal of Infection

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103

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Background: Diagnosis and screening of frailty, a condition characterized by an increased vulnerability to adverse outcomes of COVID-19, has emerged as an essential clinical tool which is strongly recommended by healthcare providers concerned with hospitalized elderly population. The data showing the role of frailty in patients infected with COVID-19 is needed. Methods: This was a nationwide cohort study conducted at all hospitals in Turkey. All COVID-19 hospitalized patients (≥ 65 years) were included. Patients who were alive and not discharged up to July 20, 2020, were excluded. The frailty was assessed by using the "Hospital Frailty Risk Score" (HFRS). Patients were classified into three risk groups of frailty based on previously validated cut points as low (< 5 points), intermediate (5-15 points), and high (> 15 points). Additionally, patients who had the HFRS of ≥5 were defined as frail. The primary outcome was in-hospital mortality rates by frailty group.

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Section: Introductionmentioning

confidence: 99%

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

Kundi

Çetin

Canpolat

et al. 2020

Journal of Infection

Self Cite

103

View full text Add to dashboard Cite

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“…In particular, the HFRS was derived in a British cohort over 75 years of age, though it has been demonstrated to perform well in younger cohorts. (41) Although the median age in our cohort was much younger, we would argue that the chronological age in cirrhosis is less relevant with regard to frailty given the tendency toward sarcopenia and disability. However, the difference in age distribution between cohorts may help explain the finding that increased odds of ACLF hospitalization were most notably increased at very high ranges of HFRS score, beyond the >15 cut point previously described to represent high-risk frailty.…”

Section: Original Article | 25mentioning

confidence: 71%

Patient Frailty Is Independently Associated With the Risk of Hospitalization for Acute‐on‐Chronic Liver Failure

Sj¹,

Goldberg²,

Kaplan³

et al. 2020

Liver Transpl.

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There is significant interest in identifying risk factors associated with acute-on-chronic liver failure (ACLF). In transplant candidates, frailty predicts wait-list mortality and posttransplant outcomes. However, the impact of frailty on ACLF development and mortality is unknown. This was a retrospective study of US veterans with cirrhosis identified between 2008 and 2016. First hospitalizations were characterized as ACLF or non-ACLF admissions. Prehospitalization patient frailty was ascertained using a validated score based on administrative coding data. We used logistic regression to investigate the impact of an increasing frailty score on the odds of ACLF hospitalization and short-term ACLF mortality. Cox regression was used to analyze the association between frailty and longterm survival from hospitalization. We identified 16,561 cirrhosis hospitalizations over a median follow-up of 4.19 years (interquartile range, 2.47-6.34 years). In adjusted models, increasing frailty score was associated with significantly increased odds of ACLF hospitalization versus non-ACLF hospitalization (odds ratio, 1.03 per point; 95% CI 1.02-1.03; P < 0.001). By contrast, frailty score was not associated with ACLF 28-or 90-day mortality (P = 0.13 and P = 0.33, respectively). In an adjusted Cox analysis of all hospitalizations, increasing frailty scores were associated with poorer longterm survival from the time of hospitalization (hazard ratio, 1.02 per 5 points; 95% confidence interval, 1.01-1.03; P = 0.004). Frailty increases the likelihood of ACLF hospitalization among patients with cirrhosis, but it does not impact short-term ACLF mortality. These findings have implications for clinicians caring for frail outpatients with cirrhosis, including tailored follow-up, risk mitigation strategies, and possible expedited transplant evaluation.

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“…Since there were overlaps among the geriatric syndromes, and there was a lack of information regarding the prevalence of the overlapping conditions, we were only able to approximate the prevalence from the literature. For example, the literature reported that the rate of delirium up to 44%, dementia 32%, and frailty 49%, 5,7,11,24,25 but we were able to construct the data set with delirium at 43%, dementia 34%, and frailty 47%. Nevertheless, the importance of further study using prospective data with more accurate clinical information regarding geriatric syndromes to assess the interactions on economic outcome cannot be ignored in order to validate the result of the current retrospective study.…”

Section: Figure 2 Predicted Average Total Hospital Cost Of Each Condmentioning

confidence: 97%

“…Furthermore, it does not provide information of HCPCS codes or antipsychotics use to increase the sensitivity of identifying frailty and delirium per the algorithm by Kim et al 14,15 To overcome this limitation, we constructed a new data set by resampling the original data to approximate the prevalence of geriatric syndromes from the literature. 5,7,11,24,25 With multiple resampling and repetition, 26 we were able to create a simulated data set with a rate of delirium among TAVR patients as 43%, 34% for dementia, and 47% for frailty. With the new simulated data set, we repeated the process of obtaining the final model to estimate the association of combinations of geriatric syndromes and the outcome.…”

Section: Sensitivity Analysismentioning

confidence: 99%

The Association of Economic Outcome and Geriatric Syndromes among Older Adults with Transcatheter Aortic Valve Replacement (TAVR)

Kwak

Rasu

Morgan

et al. 2020

JHEOR

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Background: The association of geriatric syndromes and economic outcomes among patients who are undergoing transcatheter aortic valve replacement (TAVR) remains unknown. Methods and Results: A retrospective observational study using the National Inpatient Sample (NIS) from 2011 to 2014 was conducted with 7078 patients who were 65 years or older and underwent TAVR. The average hospital cost was US$58 703 (± SD 29 777) and length of stay (LOS) was 8.1 days (±7.20). The rates of delirium, dementia, and frailty were 8.0%, 6.1%, and 10.5%, respectively. From a multivariable generalized linear regression, delirium increased the cost by 31.5% (95% CI 25.41~37.92) and LOS by 70.3% (95% CI 60.20~83.38). Frailty increased the cost by 7.4% (95% CI 3.44~11.53) and the LOS by 22.6% (95% CI 15.15~30.55). Dementia had no significant association with either outcome. When the interactions of the geriatric syndromes were tested for association with the outcomes, delirium in the absence of dementia but presence of frailty showed the strongest association with cost (increase by 45.1%, 95% CI 26.45~66.45), and delirium in the absence of both dementia and frailty showed the strongest association with LOS (increase by 74.5%, 95% CI 62.71~87.13). When the average hospital cost and LOS were predicted using the model with interaction terms, patients with delirium and frailty (but without dementia) had the highest value (total hospital cost US$86 503 and LOS 14.9 days). Conclusion: Among TAVR patients, delirium was significantly associated with increased hospital cost and LOS, and the association was significantly higher in the absence of dementia. The results of this study will be a great asset for health care providers and administrators in planning for efficient care strategy to lower health care expenditure in the hospital for older adults who underwent TAVR.

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Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort

Cited by 86 publications

References 31 publications

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

Patient Frailty Is Independently Associated With the Risk of Hospitalization for Acute‐on‐Chronic Liver Failure

The Association of Economic Outcome and Geriatric Syndromes among Older Adults with Transcatheter Aortic Valve Replacement (TAVR)

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