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Association Between Claims‐Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND‐DAPT Study
BACKGROUND: Frailty is rarely assessed in clinical trials of patients who receive dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. This study investigated whether frailty defined using claims data is associated with outcomes following percutaneous coronary intervention, and...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10382113/ https://www.ncbi.nlm.nih.gov/pubmed/37449567 http://dx.doi.org/10.1161/JAHA.123.029588 |
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author | Faridi, Kamil F. Strom, Jordan B. Kundi, Harun Butala, Neel M. Curtis, Jeptha P. Gao, Qi Song, Yang Zheng, Luke Tamez, Hector Shen, Changyu Secemsky, Eric A. Yeh, Robert W. |
author_facet | Faridi, Kamil F. Strom, Jordan B. Kundi, Harun Butala, Neel M. Curtis, Jeptha P. Gao, Qi Song, Yang Zheng, Luke Tamez, Hector Shen, Changyu Secemsky, Eric A. Yeh, Robert W. |
author_sort | Faridi, Kamil F. |
collection | PubMed |
description | BACKGROUND: Frailty is rarely assessed in clinical trials of patients who receive dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. This study investigated whether frailty defined using claims data is associated with outcomes following percutaneous coronary intervention, and if there is a differential association in patients receiving standard versus extended duration DAPT. METHODS AND RESULTS: Patients ≥65 years of age in the DAPT (Dual Antiplatelet Therapy) Study, a randomized trial comparing 30 versus 12 months of DAPT following percutaneous coronary intervention, had data linked to Medicare claims (n=1326), and a previously validated claims‐based index was used to define frailty. Net adverse clinical events, a composite of all‐cause mortality, myocardial infarction, stroke, and major bleeding, were compared between frail and nonfrail patients. Patients defined as frail using claims data (12.0% of the cohort) had higher incidence of net adverse clinical events (23.1%) compared with nonfrail patients (10.7%; P<0.001) at 18‐month follow‐up and increased risk after multivariable adjustment (adjusted hazard ratio [HR], 2.24 [95% CI, 1.38–3.63]). There were no differences in effects of extended duration DAPT on net adverse clinical events for frail (HR, 1.42 [95% CI, 0.73–2.75]) and nonfrail patients (HR, 1.18 [95% CI, 0.83–1.68]; interaction P=0.61), although analyses were underpowered. Bleeding was highest among frail patients who received extended duration DAPT. CONCLUSIONS: Among older patients in the DAPT Study, claims‐defined frailty was associated with higher net adverse clinical events. Effects of extended duration DAPT were not different for frail patients, although comparisons were underpowered. Further investigation of how frailty influences ischemic and bleeding risks with DAPT are warranted. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00977938. |
format | Online Article Text |
id | pubmed-10382113 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-103821132023-07-29 Association Between Claims‐Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND‐DAPT Study Faridi, Kamil F. Strom, Jordan B. Kundi, Harun Butala, Neel M. Curtis, Jeptha P. Gao, Qi Song, Yang Zheng, Luke Tamez, Hector Shen, Changyu Secemsky, Eric A. Yeh, Robert W. J Am Heart Assoc Original Research BACKGROUND: Frailty is rarely assessed in clinical trials of patients who receive dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. This study investigated whether frailty defined using claims data is associated with outcomes following percutaneous coronary intervention, and if there is a differential association in patients receiving standard versus extended duration DAPT. METHODS AND RESULTS: Patients ≥65 years of age in the DAPT (Dual Antiplatelet Therapy) Study, a randomized trial comparing 30 versus 12 months of DAPT following percutaneous coronary intervention, had data linked to Medicare claims (n=1326), and a previously validated claims‐based index was used to define frailty. Net adverse clinical events, a composite of all‐cause mortality, myocardial infarction, stroke, and major bleeding, were compared between frail and nonfrail patients. Patients defined as frail using claims data (12.0% of the cohort) had higher incidence of net adverse clinical events (23.1%) compared with nonfrail patients (10.7%; P<0.001) at 18‐month follow‐up and increased risk after multivariable adjustment (adjusted hazard ratio [HR], 2.24 [95% CI, 1.38–3.63]). There were no differences in effects of extended duration DAPT on net adverse clinical events for frail (HR, 1.42 [95% CI, 0.73–2.75]) and nonfrail patients (HR, 1.18 [95% CI, 0.83–1.68]; interaction P=0.61), although analyses were underpowered. Bleeding was highest among frail patients who received extended duration DAPT. CONCLUSIONS: Among older patients in the DAPT Study, claims‐defined frailty was associated with higher net adverse clinical events. Effects of extended duration DAPT were not different for frail patients, although comparisons were underpowered. Further investigation of how frailty influences ischemic and bleeding risks with DAPT are warranted. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00977938. John Wiley and Sons Inc. 2023-07-14 /pmc/articles/PMC10382113/ /pubmed/37449567 http://dx.doi.org/10.1161/JAHA.123.029588 Text en © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Faridi, Kamil F. Strom, Jordan B. Kundi, Harun Butala, Neel M. Curtis, Jeptha P. Gao, Qi Song, Yang Zheng, Luke Tamez, Hector Shen, Changyu Secemsky, Eric A. Yeh, Robert W. Association Between Claims‐Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND‐DAPT Study |
title | Association Between Claims‐Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND‐DAPT Study |
title_full | Association Between Claims‐Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND‐DAPT Study |
title_fullStr | Association Between Claims‐Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND‐DAPT Study |
title_full_unstemmed | Association Between Claims‐Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND‐DAPT Study |
title_short | Association Between Claims‐Defined Frailty and Outcomes Following 30 Versus 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Findings From the EXTEND‐DAPT Study |
title_sort | association between claims‐defined frailty and outcomes following 30 versus 12 months of dual antiplatelet therapy after percutaneous coronary intervention: findings from the extend‐dapt study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10382113/ https://www.ncbi.nlm.nih.gov/pubmed/37449567 http://dx.doi.org/10.1161/JAHA.123.029588 |
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