Impact of Frailty on Outcomes After Transcatheter Edge-to-Edge Repair With MitraClip (from the National Inpatient Sample Database)

Rios, Saul; Li, Weijia; Mustehsan, Mohammad Hashim; Hajra, Adrija; Takahashi, Tatsunori; Jin, Chengyue; Wu, Lei; Katamreddy, Adarsh; Ghalib, Natasha; Scotti, Andrea; Kobayashi, Yuhei; Latib, Azeem

doi:10.1016/j.amjcard.2022.06.019

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…Frailty measures, as shown in observational studies of TEER to have prognostic impact on long-term outcomes, including mortality, were not collected in the COAPT trial. 30,31 Though imperfect as a surrogate for frailty, the 6-min walk test was shown to have prognostic value for patients selected for TEER and we demonstrated that there was no interaction between the 6-min walk test and the effectiveness of TEER. 32 Lastly, evaluating nutritional status, such as with a nutritional risk index, may provide a more comprehensive and accurate assessment of true nutritional status and has well-established prognostic implications in ambulatory patients with HF.…”

Section: Discussionmentioning

confidence: 61%

“…Given that serum albumin is produced by the liver, liver function tests would ideally have been also collected at baseline. Frailty measures, as shown in observational studies of TEER to have prognostic impact on long‐term outcomes, including mortality, were not collected in the COAPT trial 30,31 . Though imperfect as a surrogate for frailty, the 6‐min walk test was shown to have prognostic value for patients selected for TEER and we demonstrated that there was no interaction between the 6‐min walk test and the effectiveness of TEER 32 .…”

Section: Discussionmentioning

confidence: 73%

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Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Feng

Ambrosy

Zhou

et al. 2023

European J of Heart Fail

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Aims Low serum albumin levels are associated with poor prognosis in numerous chronic disease states but the relationship between albumin and outcomes in patients with heart failure (HF) and secondary mitral regurgitation (SMR) has not been described. Methods and results The randomized COAPT trial evaluated the safety and effectiveness of transcatheter edge‐to‐edge repair (TEER) with the MitraClipTM plus guideline‐directed medical therapy (GDMT) versus GDMT alone in patients with symptomatic HF and moderate‐to‐severe or severe SMR. Baseline serum albumin levels were measured at enrolment. Among 614 patients enrolled in COAPT, 559 (91.0%) had available baseline serum albumin levels (median 4.0 g/dl, interquartile range 3.7–4.2 g/dl). Patients with albumin <4.0 g/dl compared with ≥4.0 g/dl were older and more likely to have ischaemic cardiomyopathy and a hospitalization within the year prior to enrolment. After multivariable adjustment, patients with albumin <4.0 g/dl had higher 4‐year rates of all‐cause death (63.7% vs. 47.6%; adjusted hazard ratio 1.34, 95% confidence interval 1.02–1.74; p = 0.032), but there were no significant differences in HF hospitalizations (HFH) or all‐cause hospitalizations according to baseline serum albumin level. The relative effectiveness of TEER plus GDMT versus GDMT alone was consistent in patients with low and high albumin levels (pinteraction = 0.19 and 0.35 for death and HFH, respectively). Conclusion Low baseline serum albumin levels were independently associated with reduced 4‐year survival in patients with HF and severe SMR enrolled in the COAPT trial, but not with HFH. Patients treated with TEER derived similarly robust reductions in both death and HFH regardless of baseline albumin level.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 73%

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Feng

Ambrosy

Zhou

et al. 2023

European J of Heart Fail

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“…Our findings notably incorporate adjustment for levels of baseline frailty. As frailty is frequently used to risk stratify patients for high-risk interventions such as aortic valve replacement, 10,12,46,47 mitral valve procedures, 36,48,49 and left atrial appendage closure, 37,38 our results suggest a possible additional role for measures of frailty progression, derived from serial frailty measurements, to guide risk conversations. Given the higher a risk of adverse outcomes in those with frailty progression is independent of baseline frailty, these data may suggest a role for frailty trajectory assessment for those without frailty to define a higher-risk cohort.…”

Section: Discussionmentioning

confidence: 81%

“…Frailty, regardless how it is measured, has been shown to be an independent risk factor for adverse health outcomes after cardiac and non-cardiac procedures and has been previously used to risk stratify patients for invasive and high-risk interventions. 10,[35][36][37][38] As a corollary to this, there have been strategies such as pre-rehabilitation, entailing physical therapy with a goal of improving one's functional status prior to a procedure, and geriatric co-management, that have been suggested to attenuate the effect of frailty on risk. 21,22,39,40 While the impact of pre-12 rehabilitation efforts has been mixed, intrinsic to this premise is the notion that frailty is at least partially mutable.…”

Section: Discussionmentioning

confidence: 99%

Progression of Frailty and Cardiovascular Outcomes Among Medicare Beneficiaries

Gong,

Song,

et al. 2024

Preprint

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Background: Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression remains uncertain. Methods: Medicare Fee-for-service beneficiaries ≥ 65 years at cohort inception with continuous enrollment from 2003-2015 were included. Frailty trajectory was measured by annualized change in a validated claims-based frailty index (CFI) over a 5-year period. Linear mixed effects models, adjusting for baseline frailty, were used to estimate CFI change over a 5-year period. Survival analysis was used to evaluate associations of frailty progression and future health outcomes (major adverse cardiovascular and cerebrovascular events [MACCE], all-cause death, heart failure, myocardial infarction, ischemic stroke, and days alive at home [DAH] within the following calendar year). Results: 26.4 million unique beneficiaries were included (mean age 75.4 ± 7.0 years, 57% female, 13% non-White). In total, 20% had frailty progression, 66% had no change in frailty, and 14% frailty regression over median follow-up of 2.4 years. Compared to those without a change in CFI, when adjusting for baseline frailty, those with frailty progression had significantly greater risk of incident MACCE (hazard ratio [HR] 2.30, 95% confidence interval [CI] 2.30-2.31), all-cause mortality (HR 1.59, 95% CI 1.58-1.59), acute myocardial infarction (HR 1.78, 95% CI 1.77-1.79), heart failure (HR 2.78, 95% CI 2.77-2.79), and stroke (HR 1.78, 95% CI 1.77-1.79). There was also a graded increase in risk of each outcome with more rapid progression and significantly fewer DAH with the most rapid vs. the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87-0.88, p < 0.001). Conclusions: In this large, nationwide sample of Medicare beneficiaries, frailty progression, independent of baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and stroke compared to those without progression.

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“… 2 Furthermore, TEER was still able to be performed among frail patients and was effective in improving their quality of life, despite them being more prone to increased mortality and respiratory failure, as well as longer hospital stays, compared with non-frail ones. 5 …”

Section: Introductionmentioning

confidence: 99%

Cardiac rehabilitation for elderly, weak patients who undergo transcatheter edge-to-edge repair: a case report

Zou,

Zhang,

Yuan

et al. 2023

European Heart Journal - Case Reports

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Background The positive role of rehabilitation programmes for some cardiac patient populations (e.g. coronary artery disease, heart failure, transcatheter aortic valve replacement, and heart transplantation) is now well-known. However, the feasibility and outcomes of rehabilitation, prior to or immediately after percutaneous mitral valve reconstruction, using a clamping procedure have been poorly reported, especially among frail elderly patients. Case summary An 85-year-old woman with acute heart failure symptoms (New York Heart Association functional class III), who had acute myocardial infarction 3 months ago, was hospitalized. An ultrasound cardiogram showed severe mitral regurgitation, and after a multidisciplinary discussion, transcatheter edge-to-edge repair (TEER) was considered the safest treatment option. Even then, though, due to her poor health status, it was still too risky for the patient to undergo without significant prior preparation. Thus, we decided to begin pre- and post-surgery cardiac rehabilitation (CR) to prepare her for TEER, comprising medicinal, nutritional, and psychological support, as well as exercise and smoking cessation. After pre-operative assessment and rehabilitation, the patient underwent TEER, followed by post-operative reassessment, and continued rehabilitation. Discussion Our case study demonstrates that CR, both pre- and post-TEER, aids in improving the conditions of elderly patients with poor health, to minimize their risk for developing TEER-related complications. This case provides one possible CR regimen for those patients.

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Impact of Frailty on Outcomes After Transcatheter Edge-to-Edge Repair With MitraClip (from the National Inpatient Sample Database)

Cited by 11 publications

References 15 publications

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Progression of Frailty and Cardiovascular Outcomes Among Medicare Beneficiaries

Cardiac rehabilitation for elderly, weak patients who undergo transcatheter edge-to-edge repair: a case report

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