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Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis
BACKGROUND: 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....
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601523/ https://www.ncbi.nlm.nih.gov/pubmed/34793514 http://dx.doi.org/10.1371/journal.pone.0259863 |
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author | Hadaya, Joseph Tran, Zachary Sanaiha, Yas Aguayo, Esteban Dobaria, Vishal Calfon Press, Marcella Benharash, Peyman |
author_facet | Hadaya, Joseph Tran, Zachary Sanaiha, Yas Aguayo, Esteban Dobaria, Vishal Calfon Press, Marcella Benharash, Peyman |
author_sort | Hadaya, Joseph |
collection | PubMed |
description | BACKGROUND: 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. OBJECTIVE: The purpose of the present study was to evaluate the impact of frailty on clinical outcomes and resource use following transcatheter mitral valve repair (TMVR). METHODS: Adults 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. RESULTS: Of 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. CONCLUSIONS: Frailty 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. |
format | Online Article Text |
id | pubmed-8601523 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-86015232021-11-19 Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis Hadaya, Joseph Tran, Zachary Sanaiha, Yas Aguayo, Esteban Dobaria, Vishal Calfon Press, Marcella Benharash, Peyman PLoS One Research Article BACKGROUND: 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. OBJECTIVE: The purpose of the present study was to evaluate the impact of frailty on clinical outcomes and resource use following transcatheter mitral valve repair (TMVR). METHODS: Adults 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. RESULTS: Of 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. CONCLUSIONS: Frailty 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. Public Library of Science 2021-11-18 /pmc/articles/PMC8601523/ /pubmed/34793514 http://dx.doi.org/10.1371/journal.pone.0259863 Text en © 2021 Hadaya et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Hadaya, Joseph Tran, Zachary Sanaiha, Yas Aguayo, Esteban Dobaria, Vishal Calfon Press, Marcella Benharash, Peyman Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis |
title | Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis |
title_full | Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis |
title_fullStr | Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis |
title_full_unstemmed | Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis |
title_short | Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis |
title_sort | impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: a national analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601523/ https://www.ncbi.nlm.nih.gov/pubmed/34793514 http://dx.doi.org/10.1371/journal.pone.0259863 |
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