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Role of Frailty in Identifying Benefit From Transcatheter Versus Surgical Aortic Valve Replacement
- Source :
- Circ Cardiovasc Qual Outcomes
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Background: Frailty is associated with a higher risk for adverse outcomes after aortic valve replacement (AVR) for severe aortic valve stenosis, but whether or not frail patients derive differential benefit from transcatheter (TAVR) versus surgical (SAVR) AVR is uncertain. Methods: We linked adults ≥65 years old in the US CoreValve HiR trial (High-Risk) or SURTAVI trial (Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients) to Medicare claims, February 2, 2011, to September 30, 2015. Two frailty measures, a deficit-based and phenotype-based frailty index (FI), were generated. The treatment effect of TAVR versus SAVR was evaluated within FI tertiles for the primary end point of death and nondeath secondary outcomes, using multivariable Cox regression. Results: Of 1442 (linkage rate =60.0%) individuals included, 741 (51.4%) individuals received TAVR and 701 (48.6%) received SAVR (mean age 81.8±6.1 years, 44.0% female). Although 1-year death rates in the highest FI tertiles (deficit-based FI 36.7% and phenotype-based FI 33.8%) were 2- to 3-fold higher than the lowest tertiles (deficit-based FI 13.4%; hazard ratio, 3.02 [95% CI, 2.26–4.02], P P P >0.05). Results remained consistent across individual trials, frailty definitions, and when considering the nonlinked trial data. Conclusions: Two different frailty indices based on Fried and Rockwood definitions identified individuals at higher risk of death and functional impairment but no differential benefit from TAVR versus SAVR.
- Subjects :
- Male
medicine.medical_specialty
Adverse outcomes
Medicare
Article
Transcatheter Aortic Valve Replacement
Aortic valve replacement
Risk Factors
Internal medicine
medicine
Humans
Aged
Aged, 80 and over
Heart Valve Prosthesis Implantation
Frailty
business.industry
Aortic Valve Stenosis
medicine.disease
United States
Treatment Outcome
Aortic Valve
Aortic valve stenosis
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 19417705 and 19417713
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- Circulation: Cardiovascular Quality and Outcomes
- Accession number :
- edsair.doi.dedup.....261ec5bdde0fb3017a6278f154dda66a