Impact of Frailty on Mortality, Readmissions, and Resource Utilization After TAVI

Malik, Aaqib H; Yandrapalli, Srikanth; Zaid, Syed; Shetty, Suchith; Athar, Ammar; Gupta, Rahul; Aronow, Wilbert S.; Goldberg, Joshua; Cohen, Martin; Ahmad, Hasan; Lansman, Steven L.

doi:10.1016/j.amjcard.2020.03.047

Cited by 24 publications

(7 citation statements)

References 20 publications

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“…In the current study, TAVR was associated with a lower risk of all-cause mortality, CV death, and major adverse cardiovascular events among patients with a relatively low hospital frailty score. This result was consistent with previous studies showing that frail patients inevitably face an elevated risk of mortality after receiving TAVR ( 31 – 33 ). All-cause mortality at 1 year after TAVR in this study (11.39%) was lower than that of the high-risk patient in the PARTNER I trial (24.2%) ( 3 ).…”

Section: Discussionsupporting

confidence: 93%

“…The Elixhauser comorbidity index includes 31 comorbidities, including congestive heart failure, cardiac arrhythmias, valvular disease, pulmonary circulation disorders, chronic pulmonary disease, complicated diabetes, renal failure, and coagulopathy ( 42 , 43 ). The hospital frailty score is a significant predictor of all-cause mortality and rehospitalization among patients receiving TAVR ( 33 , 44 ). Through these means, we may adjust the severity indirectly and our results reported survival benefit of TAVR with comparable post-procedure costs.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes and cumulative healthcare costs of TAVR vs. SAVR in Asia

Tan

Lee

Kuo

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesThis study compared transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in terms of short- and long-term effectiveness.MethodsThis retrospective cohort study based on nationwide National Health Insurance claims data and Cause of Death data focused on adult patients (n = 3,643) who received SAVR (79%) or TAVR (21%) between 2015 and 2019. Propensity score overlap weighting was applied to account for selection bias. Primary outcomes included all-cause mortality (ACM), hospitalization for heart failure, and a composite endpoint of major adverse cardiac events (MACE). Secondary outcomes included medical utilization, hospital stay, and total medical costs at index admission for the procedure and in various post-procedure periods. The Cox proportional-hazard model with competing risk was used to investigate survival and incidental health outcomes. Generalized estimation equation (GEE) models were used to estimate differences in the utilization of medical resources and overall costs.ResultsAfter weighting, the mean age of the patients was 77.98 ± 5.86 years in the TAVR group and 77.98 ± 2.55 years in the SAVR group. More than half of the patients were female (53.94%). The incidence of negative outcomes was lower in the TAVR group than in the SAVR group, including 1-year ACM (11.39 vs. 17.98%) and 3-year ACM (15.77 vs. 23.85%). The risk of ACM was lower in the TAVR group (HR [95% CI]: 0.61 [0.44–0.84]; P = 0.002) as was the risk of CV death (HR [95% CI]: 0.47 [0.30–0.74]; P = 0.001) or MACE (HR [95% CI]: 0.66 [0.46–0.96]; P = 0.0274). Total medical costs were significantly higher in the TAVR group than in the SAVR in the first year after the procedure ($1,271.89 ± 4,048.36 vs. $887.20 ± 978.51; P = 0.0266); however, costs were similar in the second and third years after the procedure. The cumulative total medical costs after the procedure were significantly higher in the TAVR group than in the SAVR group (adjusted difference: $420.49 ± 176.48; P = 0.0172).ConclusionIn this real-world cohort of patients with aortic stenosis, TAVR proved superior to SAVR in terms of clinical outcomes and survival with comparable medical utilization after the procedure.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and cumulative healthcare costs of TAVR vs. SAVR in Asia

Tan

Lee

Kuo

et al. 2022

Front. Cardiovasc. Med.

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“…2016 34 C 6 L 166 — 49 — 23 ± 15 — 45 0 90 10 Malik et al. 2020 35 C 1 L 20,504 80.6 ± 8.3 45.9 — — — — — — — Saji et al. 2018 36 C 3 B 155 85 (82–88) 65 6 (4.7–8.2) — — 74 91 8.3 0.7 Deharo et al.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review

et al. 2022

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“…Together, these mechanistic studies suggest that reduced circulating musclin might indicate low physical activity, impaired exercise capacity, or frailty, which are all known drivers of adverse outcomes after TAVI, still insufficiently mapped by conventional clinical risk scores. 45 , 46 , 47 , 48 Indeed, patient populations undergoing TAVI are heterogeneous with regard to subclinical TAVI‐specific risk factors (such as nutritional status 49 or physical impairments 28 , 29 ) and circulating biomarkers (such as circulating musclin levels) may be more appropriate to integrate these TAVI‐specific risk factors compared with restrictive definitions assessed by EuroSCORE II (eg, severe impairment of mobility), which will become even more important with the expansion of TAVI procedures in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Low Circulating Musclin is Associated With Adverse Prognosis in Patients Undergoing Transcatheter Aortic Valve Implantation at Low‐Intermediate Risk

Kattih

Carstens

Boeckling

et al. 2022

JAHA

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Background Musclin is an activity‐stimulated and cardioprotective myokine that attenuates pathological cardiac remodeling. Musclin deficiency, in turn, results in reduced physical endurance. The aim of this study was to assess the prognostic value of circulating musclin as a novel, putative biomarker to identify patients undergoing transcatheter aortic valve implantation (TAVI) who are at a higher risk of death. Methods and Results In this study, we measured systemic musclin levels in 368 patients undergoing TAVI who were at low to intermediate clinical risk (median EuroSCORE [European System for Cardiac Operative Risk Evaluation] II: 3.5; quartile 1–quartile, 2.2%–5.3%), whereby 209 (56.8%) patients were at low and 159 (43.2%) were at intermediate risk. Median preprocedural musclin levels were 2.7 ng/mL (quartile 1–quartile 3, 1.5–4.6 ng/mL). Musclin levels were dichotomized in low (<2.862 ng/mL, n=199 [54.1%]) or high (≥ 2.862 ng/mL, n=169 [45.9%]) groups using cutoff values determined by classification and regression tree analysis. The primary end point was 1‐year overall survival. Patients with low circulating musclin levels exhibited a significantly higher prevalence of frailty, low albumin values, hypertension, and history of stroke as well as higher N‐terminal pro‐B‐type natriuretic peptide. Low musclin levels significantly predicted risk of death in univariable (hazard ratio, 1.81; 95% CI, 1.00–3.53 [ P =0.049]) and multivariable (adjusted hazard ratio, 2.45; 95% CI, 1.06–5.69 [ P =0.037]) Cox regression analyses. Additionally, low musclin levels in combination with conventional EuroSCORE II suggested improved risk stratification in patients undergoing TAVI who were at low to intermediate clinical risk into subgroups with reduced 1‐year survival rates by log‐rank test ( P for trend=0.003). Conclusions Circulating musclin is an independent predictor of 1‐year overall survival in patients undergoing TAVI. Combined with EuroSCORE II, circulating musclin might help to improve prediction of mortality in patients undergoing TAVI who are at low to intermediate clinical risk.

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Impact of Frailty on Mortality, Readmissions, and Resource Utilization After TAVI

Cited by 24 publications

References 20 publications

Clinical outcomes and cumulative healthcare costs of TAVR vs. SAVR in Asia

Clinical outcomes and cumulative healthcare costs of TAVR vs. SAVR in Asia

Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review

Low Circulating Musclin is Associated With Adverse Prognosis in Patients Undergoing Transcatheter Aortic Valve Implantation at Low‐Intermediate Risk

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