The Influence of the Charlson Comorbidity Index on Procedural Characteristics, VARC-2 Endpoints and 30-Day Mortality Among Patients Who Undergo Transcatheter Aortic Valve Implantation

George, Sudhakar; Kwok, Chun Shing; Martin, Glen P.; Babu, Aswin; Shufflebotham, Adrian; Nolan, James; Ratib, Karim; Bagur, Rodrigo; Gunning, Mark; Mamas, Mamas A.

doi:10.1016/j.hlc.2018.11.006

Cited by 9 publications

(7 citation statements)

References 39 publications

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“…In contrast, many patients with lower CCI classification have undergone in SAVR. These results are consistent with the literature,19 20 22 32 33 which suggests that TAVI is usually performed more often in patients with grater frailty.…”

Section: Discussionsupporting

confidence: 93%

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Spatial analysis and factors associated with transcatheter aortic valve implantation in Portugal: a retrospective analysis from 2015 to 2017

2023

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ObjectivesTo identify the factors associated with transcatheter aortic valve implantation (TAVI) use of TAVI in inpatients with aortic stenosis (AS) in Portugal and its geographical distribution.MethodsA quantitative, observational and retrospective study using the Portuguese National Health Service inpatient discharge database from 2015 to 2017. Surgical aortic valve replacement (SAVR) and TAVI procedures were selected using the International Classification of Diseases. First, we mapped the yearly age-standardised rate for each procedure using QGIS. Then, we performed χ2tests, independent t-tests and logistic regressions to study the factors associated with TAVI use.ResultsFrom 2015 to 2017, 8398 hospitalisations were selected, 88.5% SAVR and 11.5% TAVI. From 2015 to 2017, SAVR use increased in the Northern region and decreased in the Lisbon region, while the opposite was observed for TAVI. TAVI was performed among the most complex (p<0.001) and older patients (the mean (SD) age for SAVR was 70 (±11) years old and 81 (±7) years old for TAVI, p<0.001). The results for the logistic regressions showed that, more recent hospitalisations, being older, living in the Lisbon region and having a higher Charlson Comorbidity Index was associated with an increased likelihood of undergoing TAVI (p<0.001).ConclusionsTAVI increased over the years. TAVI is more often performed in more severe patients as an alternative to SAVR with similar discharge outcomes. These results suggest the existence of geographic disparities in the availability and access to healthcare services and technologies.

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Section: Discussionsupporting

confidence: 93%

“…Therefore, the results should be interpreted as associations between the variables. Finally, the CCI is represented by a specific group of comorbidities commonly used in observational studies 19 20 22 32. Other important comorbidities might influence AS severity and medical decision on therapeutic choice might not be considered.…”

Section: Discussionmentioning

confidence: 99%

Spatial analysis and factors associated with transcatheter aortic valve implantation in Portugal: a retrospective analysis from 2015 to 2017

2023

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“…Studies have shown that among individuals ≥80 years of age, >80% of this population present with multiple comorbid conditions, and comorbidity burden is a strong predictor of poor outcomes. 14 , 15 , 19 , 20 , 21 , 22 , 23 One potential explanation for the differences in CCI and ECS (lower CCI in patients ≥80 years old while higher ECS as compared with <80 years old) would be the fact that the CCI captures about half the number of comorbidities than the ECS and, therefore, the differences in P values are likely driven by the difference in sample sizes.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure

Sanjoy

Choi

Sparrow

et al. 2021

JAHA

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Background Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in‐hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure. Methods and Results The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in‐hospital MAE defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitalizations were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were <80 years old. Patients ≥80 years old experienced a higher rate of MAE compared with those aged <80 years old (6.0% versus 4.6%, P =0.01), and this difference was driven by a numerically higher rate of cardiac complications (2.4% versus 1.8%, P =0.09) and death (0.3% versus 0.1%, P =0.05) among individuals ≥80 years old. In patients ≥80 years old, higher odds of in‐hospital MAE were observed in women (1.61‐fold), and those with preprocedural congestive heart failure (≈2‐fold), diabetes (≈1.5‐fold), renal disease (≈2.6‐fold), anemia (≈2.7‐fold), and dementia (≈5‐fold). In patients <80 years old, a higher risk of in‐hospital MAE was encountered among women (≈1.4‐fold) and those with diabetes (≈1.3‐fold), renal disease (≈2.6‐fold), anemia (≈2‐fold), and dyslipidemia (≈1.2‐fold). Conclusions Patients ≥80 years old had higher rates of in‐hospital MAE compared with patients aged <80 years old. Female sex and the presence of heart failure, diabetes, renal disease, and anemia were factors associated with in‐hospital MAE among both groups.

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“…Three claims‐based indices were chosen based on validation articles and/or application to the AVR literature, the Charlson Comorbidity Index, the Combined Comorbidity Index, and the Johns Hopkins Frailty Index, and were calculated in accordance with instructions provided by the original authors. 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 A Johns Hopkins Frailty Index cutoff of 0.20 or greater was defined as frail in accordance with guidance provided in the original article. The Combined Comorbidity Index was included in modeling out of the 3 calculated indices because it has been shown to correlate better with mortality and allowed for separate assessment of age, sex, and race.…”

Section: Methodsmentioning

confidence: 99%

Patient‐ and Process‐Related Contributors to the Underuse of Aortic Valve Replacement and Subsequent Mortality in Ambulatory Patients With Severe Aortic Stenosis

Flannery

Etiwy

Camacho

et al. 2022

JAHA

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Background Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient‐ and process‐specific factors affected AVR use in patients with severe AS. Methods and Results We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area 1.0 cm 2 . Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365 days and subsequent mortality at 730 days. Of 324 patients with an indication for AVR (79.3±9.7 years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged >90 years (odds ratio [OR], 0.24 [95% CI, 0.08–0.69]; P =0.01), greater comorbid conditions (OR, 0.88 per 1‐point increase in Combined Comorbidity Index [95% CI, 0.79–0.97]; P =0.01), low‐flow, low‐gradient AS with preserved left ventricular ejection fraction (OR, 0.11 [95% CI, 0.06–0.21]), and low‐gradient AS with reduced left ventricular ejection fraction (OR, 0.18 [95% CI, 0.08–0.40]) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 [95% CI, 1.38–4.38]). Patients who underwent AVR gained an average of 85.8 days of life (95% CI, 40.9–130.6) at 730 days. Conclusions The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low‐gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.

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The Influence of the Charlson Comorbidity Index on Procedural Characteristics, VARC-2 Endpoints and 30-Day Mortality Among Patients Who Undergo Transcatheter Aortic Valve Implantation

Cited by 9 publications

References 39 publications

Spatial analysis and factors associated with transcatheter aortic valve implantation in Portugal: a retrospective analysis from 2015 to 2017

Spatial analysis and factors associated with transcatheter aortic valve implantation in Portugal: a retrospective analysis from 2015 to 2017

Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure

Patient‐ and Process‐Related Contributors to the Underuse of Aortic Valve Replacement and Subsequent Mortality in Ambulatory Patients With Severe Aortic Stenosis

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