Ueki Chikara, Nakatani Eiji, Kaneda Hideaki, Sasaki Hatoko
Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, JPN.
Department of Biostatistics and Health Data Science, Graduate School of Medical Science Nagoya City University, Nagoya, JPN.
Cureus. 2024 Sep 8;16(9):e68922. doi: 10.7759/cureus.68922. eCollection 2024 Sep.
Prognostic prediction using objective indices is needed to optimize the indications for transcatheter aortic valve replacement (TAVR). We evaluated the impact of the Hospital Frailty Risk Score (HFRS), an International Classification of Diseases (ICD)-based frailty index, on the prognosis after TAVR in the late elderly.
We identified patients aged ≥75 years undergoing TAVR from April 2014 to September 2020 from the Shizuoka Kokuho Database (SKDB). Cox logistic regression analysis was performed to examine predictors of long-term mortality. We also evaluated the relationship between HFRS categories (low risk: <5, intermediate risk: 5-15, high risk: >15) and functional decline.
This study involved 607 patients (189 (31.1%) men) with a mean age of 85.0 years. During the median follow-up period of 20 months, survival significantly differed among HFRS categories (survival at two years; low (HFRS <5): 88.9%, intermediate (HFRS 5-15): 82.6%, high (HFRS >15): 67.7%; log-rank p = 0.002). In the multivariate regression model, male sex (hazard ratio (HR): 2.15, 95% confidence interval (CI): 1.42-3.24), preoperative care needs level of ≥3 (HR: 2.43, 95% CI: 1.17-5.06), and HFRS (HR: 1.07, 95% CI: 1.03-1.12) were significant predictors of mortality. Functional decline-free survival significantly differed among HFRS categories (event-free survival at two years; low: 79.4%, intermediate: 75.2%, high: 50.8%; log-rank p = 0.001).
The HFRS is a predictor of long-term mortality after TAVR in the late elderly and is associated with postoperative functional decline. The HFRS can provide additional information for decision-making regarding treatment strategies for the late elderly.
需要使用客观指标进行预后预测，以优化经导管主动脉瓣置换术（TAVR）的适应症。我们评估了基于国际疾病分类（ICD）的衰弱指数——医院衰弱风险评分（HFRS）对高龄老年人TAVR术后预后的影响。
我们从静冈国保数据库（SKDB）中确定了2014年4月至2020年9月期间接受TAVR的年龄≥75岁的患者。进行Cox逻辑回归分析以检查长期死亡率的预测因素。我们还评估了HFRS类别（低风险：<5，中度风险：5 - 15，高风险：>15）与功能衰退之间的关系。
本研究纳入了607例患者（189例（31.1%）男性），平均年龄为85.0岁。在20个月的中位随访期内，HFRS类别之间的生存率存在显著差异（两年生存率；低（HFRS <5）：88.9%，中度（HFRS 5 - 15）：82.6%，高（HFRS >15）：67.7%；对数秩检验p = 0.002）。在多变量回归模型中，男性（风险比（HR）：2.15，95%置信区间（CI）：1.42 - 3.24）、术前护理需求水平≥3（HR：2.43，95% CI：1.17 - 5.06）和HFRS（HR：1.07，95% CI：1.03 - 1.12）是死亡率的显著预测因素。HFRS类别之间无功能衰退的生存率存在显著差异（两年无事件生存率；低：79.4%，中度：75.2%，高：50.8%；对数秩检验p = 0.001）。
HFRS是高龄老年人TAVR术后长期死亡率的预测因素，并且与术后功能衰退相关。HFRS可为高龄老年人治疗策略的决策提供额外信息。
