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Frailty and clinical outcomes following aortic valve replacement

BACKGROUND AND AIMS: The Norton score is a well‐known scale to assess frailty. Frailty and a low Norton score are associated with complications and mortality in hospitalized patients. We aimed to evaluate whether a low Norton score is associated with surgical complications and death after aortic val...

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Autores principales: Ram, Eilon, Peled, Yael, Miller, Tali B., Dray, Efrat M., Karni, Ehud, Raanani, Ehud, Sternik, Leonid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544524/
https://www.ncbi.nlm.nih.gov/pubmed/35920838
http://dx.doi.org/10.1111/jocs.16801
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author Ram, Eilon
Peled, Yael
Miller, Tali B.
Dray, Efrat M.
Karni, Ehud
Raanani, Ehud
Sternik, Leonid
author_facet Ram, Eilon
Peled, Yael
Miller, Tali B.
Dray, Efrat M.
Karni, Ehud
Raanani, Ehud
Sternik, Leonid
author_sort Ram, Eilon
collection PubMed
description BACKGROUND AND AIMS: The Norton score is a well‐known scale to assess frailty. Frailty and a low Norton score are associated with complications and mortality in hospitalized patients. We aimed to evaluate whether a low Norton score is associated with surgical complications and death after aortic valve replacement (AVR). METHODS: From 2004 through 2020, we performed an observational study in a large tertiary medical center, which included all patients who had undergone isolated AVR surgery. Of the 1469 study patients, 618 patients (42%) had a low (<18) and 851 patients (58%) a high Norton score (≥18). RESULTS: Frailer patients with a low Norton score had higher in‐hospital mortality compared to those with a high Norton score (5.5% vs. 0.8%, p < .001). The Norton score was significantly higher among patients who survived compared to those who died (17.5 ± 2.4 vs. 11.5 ± 5.2, p < .001). A low Norton score was associated with a threefold increased risk of in‐hospital mortality (odds ratio 3.03; 95% confidence interval [CI] 1.14–0.09, p = .034). Ten‐year mortality rate was higher among frailer patients with a low compared with a high Norton score (25.9%, 13.3%; hazard ratio 0.69, CI 0.48‐0.82, p < .001). By adding a Norton score to standard prognostic factors (age, gender, comorbidities, left ventricular ejection fraction, functional class) we showed a significant improvement of 59.4% (p < .001) for predicting 1‐year mortality, and 40.6% (p < .001) for predicting 10‐year mortality. CONCLUSIONS: Our findings show that the admission Norton score is a powerful marker of short‐ and long‐term mortality, and, therefore, should be considered as a risk stratification tool in patients who are candidates for AVR.
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spelling pubmed-95445242022-10-14 Frailty and clinical outcomes following aortic valve replacement Ram, Eilon Peled, Yael Miller, Tali B. Dray, Efrat M. Karni, Ehud Raanani, Ehud Sternik, Leonid J Card Surg Original Articles BACKGROUND AND AIMS: The Norton score is a well‐known scale to assess frailty. Frailty and a low Norton score are associated with complications and mortality in hospitalized patients. We aimed to evaluate whether a low Norton score is associated with surgical complications and death after aortic valve replacement (AVR). METHODS: From 2004 through 2020, we performed an observational study in a large tertiary medical center, which included all patients who had undergone isolated AVR surgery. Of the 1469 study patients, 618 patients (42%) had a low (<18) and 851 patients (58%) a high Norton score (≥18). RESULTS: Frailer patients with a low Norton score had higher in‐hospital mortality compared to those with a high Norton score (5.5% vs. 0.8%, p < .001). The Norton score was significantly higher among patients who survived compared to those who died (17.5 ± 2.4 vs. 11.5 ± 5.2, p < .001). A low Norton score was associated with a threefold increased risk of in‐hospital mortality (odds ratio 3.03; 95% confidence interval [CI] 1.14–0.09, p = .034). Ten‐year mortality rate was higher among frailer patients with a low compared with a high Norton score (25.9%, 13.3%; hazard ratio 0.69, CI 0.48‐0.82, p < .001). By adding a Norton score to standard prognostic factors (age, gender, comorbidities, left ventricular ejection fraction, functional class) we showed a significant improvement of 59.4% (p < .001) for predicting 1‐year mortality, and 40.6% (p < .001) for predicting 10‐year mortality. CONCLUSIONS: Our findings show that the admission Norton score is a powerful marker of short‐ and long‐term mortality, and, therefore, should be considered as a risk stratification tool in patients who are candidates for AVR. John Wiley and Sons Inc. 2022-08-03 2022-10 /pmc/articles/PMC9544524/ /pubmed/35920838 http://dx.doi.org/10.1111/jocs.16801 Text en © 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Ram, Eilon
Peled, Yael
Miller, Tali B.
Dray, Efrat M.
Karni, Ehud
Raanani, Ehud
Sternik, Leonid
Frailty and clinical outcomes following aortic valve replacement
title Frailty and clinical outcomes following aortic valve replacement
title_full Frailty and clinical outcomes following aortic valve replacement
title_fullStr Frailty and clinical outcomes following aortic valve replacement
title_full_unstemmed Frailty and clinical outcomes following aortic valve replacement
title_short Frailty and clinical outcomes following aortic valve replacement
title_sort frailty and clinical outcomes following aortic valve replacement
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544524/
https://www.ncbi.nlm.nih.gov/pubmed/35920838
http://dx.doi.org/10.1111/jocs.16801
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