Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort
Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort
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在全国队列中接受经导管瓣膜治疗的患者的脆弱性和相关结局
DOI：
10.1093/eurheartj/ehz187
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发表时间：
2019-07-14
影响因子：
39.3
通讯作者：
Yeh, Robert W.
中科院分区：
文献类型：
--
作者：
Kundi, Harun;Popma, Jeffrey J.;Yeh, Robert W.
目的：我们试图确定接受经导管二尖瓣修复和经导管主动脉瓣置换术（TAVR）的虚弱个体的患病率和相关结果。方法和结果在2016年1月1日至2016年12月31日期间，在医疗保险和医疗补助服务中心医疗保险提供者和审查数据库中至少有一个经导管二尖瓣修复或TAVR程序代码的65岁及以上患者被纳入研究。医院虚弱风险评分是国际疾病分类第十版（ICD-10）基于索赔的评分，用于识别虚弱，主要结局是全因1年死亡率。3746例（11.6%）患者接受了经导管二尖瓣修复，28531例（88.4%）患者接受了TAVR。在经导管二尖瓣修复和TAVR人群中，分别有1903例（50.8%）和14938例（52.4%）患者被定义为虚弱低风险（评分15）。接受经导管二尖瓣修复术的低危患者一年死亡率为12.8%，中危患者为29.7%，高危患者为40.9% （log rank P < 0.001）。在接受TAVR的患者中，低危患者的1年死亡率为7.6%，中危患者为17.6%，高危患者为30.1% （log rank P < 0.001）。本研究使用基于ICD-10索赔的医院虚弱风险评分成功识别了美国老年人群中接受经导管瓣膜治疗后短期和长期死亡风险较高的个体。
Aims We sought to identify the prevalence and related outcomes of frail individuals undergoing transcatheter mitral valve repair and transcatheter aortic valve replacement (TAVR).Methods and results Patients aged 65 and older were included in the study if they had at least one procedural code for transcatheter mitral valve repair or TAVR between 1 January 2016 and 31 December 2016 in the Centers for Medicare and Medicaid Services Medicare Provider and Review database. The Hospital Frailty Risk Score, an International Classification of Diseases, Tenth Revision (ICD-10) claims-based score, was used to identify frailty and the primary outcome was all-cause 1-year mortality. A total of 3746 (11.6%) patients underwent transcatheter mitral valve repair and 28 531 (88.4%) underwent TAVR. In the transcatheter mitral valve repair and TAVR populations, respectively, there were 1903 (50.8%) and 14 938 (52.4%) patients defined as low risk for frailty (score 15). One-year mortality was 12.8% in low-risk patients, 29.7% in intermediate-risk patients, and 40.9% in high-risk patients undergoing transcatheter mitral valve repair (log rank P < 0.001). In patients undergoing TAVR, 1-year mortality rates were 7.6% in low-risk patients, 17.6% in intermediate-risk patients, and 30.1% in high-risk patients (log rank P < 0.001).Conclusions This study successfully identified individuals at greater risk of short- and long-term mortality after undergoing transcatheter valve therapies in an elderly population in the USA using the ICD-10 claims-based Hospital Frailty Risk Score.