Abstract
BackgroundTreatment options for mitral regurgitation range from diuretic therapy, to surgical and interventional strategies including TMVR in high-risk surgical candidates. Frailty has been associated with inferior outcomes following hospitalizations for heart failure and in open cardiac surgery.ObjectiveThe purpose of the present study was to evaluate the impact of frailty on clinical outcomes and resource use following transcatheter mitral valve repair (TMVR).MethodsAdults undergoing TMVR were identified using the 2016–2018 Nationwide Readmissions Database, and divided into Frail and Non-Frail groups. Frailty was defined using a derivative of the Johns Hopkins Adjusted Clinical Groups frailty indicator. Generalized linear models were used to assess the association of frailty with in-hospital mortality, complications, nonhome discharge, hospitalization costs, length of stay, and non-elective readmission at 90 days. Average marginal effects were used to quantify the impact of frailty on predicted mortality.ResultsOf 18,791 patients undergoing TMVR, 11.6% were considered frail. The observed mortality rate for the overall cohort was 2.2%. After adjustment, frailty was associated with increased odds of in-hospital mortality (AOR 1.8, 95% CI 1.2–2.6), corresponding to an absolute increase in risk of mortality of 1.1%. Frailty was associated with a 2.7-day (95% CI 2.1–3.2) increase in postoperative LOS, and $18,300 (95% CI 14,400–22,200) increment in hospitalization costs. Frail patients had greater odds (4.4, 95% CI 3.6–5.4) of nonhome discharge but similar odds of non-elective 90-day readmission.ConclusionsFrailty is independently associated with inferior short-term clinical outcomes and greater resource use following TMVR. Inclusion of frailty into existing risk models may better inform choice of therapy and shared decision-making.
Highlights
Mitral regurgitation (MR) is the second most common valvular disease in modern countries and is strongly associated with atrial fibrillation, congestive heart failure, and poor quality of life [1, 2]
Frailty was associated with increased odds of in-hospital mortality (AOR 1.8, 95% CI 1.2–2.6), corresponding to an absolute increase in risk of mortality of 1.1%
Frailty was associated with a 2.7-day increase in postoperative length of stay (LOS), and $18,300 increment in hospitalization costs
Summary
Mitral regurgitation (MR) is the second most common valvular disease in modern countries and is strongly associated with atrial fibrillation, congestive heart failure, and poor quality of life [1, 2]. Many patients at high surgical risk, such as those with reduced left ventricular function and pulmonary hypertension, have historically not been offered surgical therapy. Such patients often suffer from multiple heart failure episodes and require repeat hospitalizations for diuretic therapy. Transcatheter mitral valve repair (TMVR) has recently emerged as an alternative to surgery for the treatment of severe symptomatic MR, using catheter-based methods to appose the two leaflets in regions of malcoaptation [4, 5]. Treatment options for mitral regurgitation range from diuretic therapy, to surgical and interventional strategies including TMVR in high-risk surgical candidates. Frailty has been associated with inferior outcomes following hospitalizations for heart failure and in open cardiac surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
