Increasing frailty was associated with higher one-year mortality after M-TEER, with significant risk starting at care level 2 (OR 1.57; 95% CI 1.28-1.92) and peaking at care level 4 (OR 2.28).
Observational (n=4,699)
Yes
Do frailty and multimorbidity predict one-year mortality in patients undergoing mitral valve edge-to-edge repair?
Frailty and multimorbidity are strong predictors of 1-year mortality after M-TEER, highlighting the importance of patient selection, although the procedure successfully reduces heart failure hospitalizations.
Effect estimate: OR 1.57 (95% CI 1.28-1.92)
Abstract Background Mitral valve insufficiency is a common finding in the community setting and incidence increases with age. Mitral valve edge-to-edge repair (M-TEER) offers a valuable option in patients deemed unfit for surgery. Especially in those, frailty and multimorbidity play an evident role for clinical decision making. Purpose To elucidate on the role of frailty and multimorbidity on mortality after M-TEER in a large real-world patient population. Methods Data on multimorbidity, frailty and survival were drawn from the anonymized database of the second largest sickness fund in Germany, which covers approximately ten percent of the German population. German statuary health insurance holders can apply for financial assistance, which increases with the extend of functional deficits (care level, so-called "Pflegegrad"). Individual are classified into five categories, where clinical care level 1 resembles level 4 of the clinical frailty scale (CFS), and features of level 4 and 5 correspond to CFS level 7 and 8, respectively. Results In 4699 patients undergoing M-TEER, the care level at index hospitalization for the procedure and long-term follow-up was available. With increasing level of care, one-year survival probability decreased as compared to patients with no impairment of independence and abilities. This finding becomes relevant when patients present with significant limitations (care level 2: OR 1.57 95% CI 1.28;1.92) and becomes more pronounced with increasing level of care (Figure 1 spider plot, care level 3: OR 1.59 95% CI 1.21;2.09, care level 4: OR 2.28 1.31;3.91).Per added International Statistical Classification of Disease code, the survival probability decreases (OR 1.12 95% CI 1.10;1.14. Independent of care levels, predictors for one-year mortality were right heart failure (OR 1.76 1.48;2.10, dementia (OR 1.51 1.17; 1.94), and malignancy (OR 1.21 1.02;1.44), whereas obesity seems to have a protective effect (OR 0.77 0.64; 0.93). Overall medical expenses 12-months before the procedure were equal to 12-months after M-TEER (OR 1.00 95% CI 1.00; 100 per €), and the number of doctor patient contacts in the ambulatory setting remained unchanged (12-months before vs. 12-months after OR 0.99 0.98;1.00). The number of heart failure hospitalizations 12-months before M-TEER were higher as compared to 12-months after the procedure (OR 1.14 95% CI 1.06;1.23 Conclusions Frailty and multimorbidity play an important role for survival prediction in patients undergoing M-TEER. With increasing impairment of independence and abilities 12-months survival decreases. M-TEER effectively reduces the number of heart failure hospitalizations, even though overall medical expenses and number of doctor-patient contacts in the ambulatory setting remain unchanged 12-months after the intervention.
Radu et al. (Sat,) conducted a observational in Mitral valve insufficiency (n=4,699). Mitral valve edge-to-edge repair (M-TEER) vs. No impairment of independence and abilities was evaluated on One-year mortality (OR 1.57, 95% CI 1.28-1.92). Increasing frailty was associated with higher one-year mortality after M-TEER, with significant risk starting at care level 2 (OR 1.57; 95% CI 1.28-1.92) and peaking at care level 4 (OR 2.28).