Frailty as a predictor of mortality and readmission rate in secondary mitral regurgitation.

Autor: Uzel R; Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020, Salzburg, Austria. robert.uzel@bbsalz.at.; Department of Cardiology, Klinik Floridsdorf, Brünner Str. 68, 1210, Vienna, Austria. robert.uzel@bbsalz.at., Rezar R; Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria., Bruno RR; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany., Wernly S; Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstr. 37, 5110, Oberndorf, Austria., Jung C; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany., Delle Karth G; Department of Cardiology, Klinik Floridsdorf, Brünner Str. 68, 1210, Vienna, Austria., Datz C; Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstr. 37, 5110, Oberndorf, Austria., Hoppichler F; Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020, Salzburg, Austria.; Special Institute for Preventive Cardiology and Nutrition, SIPCAN-Initiative für ein gesundes Leben, Salzburg, Austria., Wernly B; Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstr. 37, 5110, Oberndorf, Austria.; Institute of general practice, family medicine and preventive medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
Jazyk: angličtina
Zdroj: Wiener klinische Wochenschrift [Wien Klin Wochenschr] 2023 Dec; Vol. 135 (23-24), pp. 696-702. Date of Electronic Publication: 2023 Jan 12.
DOI: 10.1007/s00508-022-02138-4
Abstrakt: Introduction: Selection in patients with functional mitral regurgitation (MR) to identify responders to interventions is challenging. In these patients, frailty might be used as a multidimensional parameter to summarize the resilience to stressors. Our objective was to evaluate frailty as a predictor of outcome in patients with moderate to severe secondary MR.
Methods: We conducted a single-center retrospective observational cohort study and included 239 patients with moderate to severe secondary MR aged 65 years or older between 2014 and 2020. Echocardiography was performed at baseline; frailty was evaluated using the clinical frailty scale (CFS). The combined primary endpoint was hospitalization for heart failure and all-cause mortality.
Results: A total of 53% (127) of all patients were classified as CFS 4 (living with mild frailty) or higher. Frail patients had a higher risk for the combined endpoint (hazard ratio, HR 3.70, 95% confidence interval, CI 2.12-6.47; p < 0.001), 1‑year mortality (HR 5.94, 95% CI 1.76-20.08; p < 0.001) even after adjustment for EuroSCORE2. The CFS was predictive for the combined endpoint (AUC 0.69, 95% CI 0.62-0.75) and outperformed EuroSCORE2 (AUC 0.54, 95% CI 0.46-0.62; p = 0.01). In sensitivity analyses, we found that frailty was associated with adverse outcomes at least in trend in all subgroups.
Conclusion: For older, medically treated patients with moderate to severe secondary mitral regurgitation, frailty is an independent predictor for the occurrence of death and heart failure-related readmission within 1 year and outperformed the EuroSCORE2. Frailty should be assessed routinely in patients with heart failure to guide clinical decision making for mitral valve interventions or conservative treatment.
(© 2023. The Author(s).)
Databáze: MEDLINE
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