Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York.
Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York.
Am J Cardiol. 2020 Jul 15;127:120-127. doi: 10.1016/j.amjcard.2020.03.047. Epub 2020 Apr 24.
With aging population and preponderance of severe aortic stenosis occurring in elderly patients, the number of transcatheter aortic valve implantations (TAVI) performed in the elderly are growing. Frailty is common in the elderly and is known to be associated with worse outcomes. We aimed to evaluate the impact of frailty on hospital readmissions rates after TAVI. We used the 2016 Nationwide Readmission Database and categorized patients who underwent TAVI low, intermediate, and high frailty status. The primary outcome was 6-months readmission rates across the 3 frailty categories. Secondary outcomes included causes of readmissions, in-hospital mortality and cost of care. STATA 16.0 was used for survey-specific statistical tests. Of 20,504 patients who underwent TAVI, 58.9% were low-, 39.6% were intermediate-, and 1.5% were in the high-frailty group. Overall in-hospital mortality was 1.9% (n = 396), and was 0.6%, 3.3%, and 16.8% (p <0.01) with increasing frailty. Of the 20,108 patients who survived to discharge, 6,427 (32%) patients were readmitted within 6-months after TAVI. Readmission rates increased across the categories from 27.9% in low, 37.6% in intermediate and 51.1% in high frailty group (p <0.01). While cardiac causes (mostly heart failure) were the predominant readmission etiologies across frailty categories (low: 51.2%, intermediate: 34.1%, high: 27.2%), rates of infectious and injury-related readmissions increased (low: 11%, intermediate: 30%, high: 45%). Mortality during readmissions also worsened from 0.8%, 5.3%, and 8.5% (p <0.01). Over 40% of patients undergoing TAVI were of intermediate-high frailty. In conclusion, an increasing frailty was associated with significantly worse postprocedure mortality, readmissions, and related mortality.
随着人口老龄化和老年患者严重主动脉瓣狭窄的增多，接受经导管主动脉瓣植入术（TAVI）的老年患者数量不断增加。衰弱在老年人中很常见，并且已知与更差的预后相关。我们旨在评估衰弱对 TAVI 后住院再入院率的影响。我们使用了 2016 年全国再入院数据库，并将接受 TAVI 的患者分为低、中、高衰弱状态。主要结果是 3 个衰弱类别 6 个月的再入院率。次要结果包括再入院的原因、住院死亡率和护理成本。STATA 16.0 用于调查特定的统计检验。在接受 TAVI 的 20504 名患者中，58.9%为低衰弱组，39.6%为中衰弱组，1.5%为高衰弱组。总体住院死亡率为 1.9%（n=396），衰弱程度增加，死亡率分别为 0.6%、3.3%和 16.8%（p<0.01）。在 20108 名存活至出院的患者中，6427 名（32%）患者在 TAVI 后 6 个月内再次入院。再入院率随着类别从低衰弱组的 27.9%、中衰弱组的 37.6%和高衰弱组的 51.1%增加（p<0.01）。虽然心脏原因（主要是心力衰竭）是所有衰弱组中主要的再入院病因（低衰弱组：51.2%、中衰弱组：34.1%、高衰弱组：27.2%），但感染和损伤相关的再入院率增加（低衰弱组：11%、中衰弱组：30%、高衰弱组：45%）。再入院期间的死亡率也从 0.8%、5.3%和 8.5%恶化（p<0.01）。超过 40%接受 TAVI 的患者为中高度衰弱。总之，衰弱程度的增加与术后死亡率、再入院率和相关死亡率显著恶化相关。
