Key result
Frailty was associated with a significantly higher risk of long-term all-cause mortality (adjusted HR 4.06) compared to non-frail patients undergoing concomitant valve replacement and ablation.
Why the study?
To evaluate the prognostic value of frailty on clinical and functional outcomes in older patients undergoing concomitant valve replacement and bipolar radiofrequency ablation.
Does frailty worsen clinical and functional outcomes in patients aged ≥ 65 years undergoing concomitant valve replacement and bipolar radiofrequency ablation?
Cohort (n=185)
No
Does frailty worsen clinical and functional outcomes in patients aged ≥ 65 years undergoing concomitant valve replacement and bipolar radiofrequency ablation?
Hazard Ratio: 4.06 (95% CI 1.33–12.38)
Absolute Event Rate: 22.39% vs 5.93%
p-value: p=0.014
Frailty is an independent risk factor for long-term all-cause mortality, rehospitalization, and poorer quality of life in older patients undergoing concomitant valve replacement and atrial fibrillation ablation.
Frailty signals higher mortality and complication risks after valve surgery with ablation; leaves open whether mitigation strategies improve outcomes.
BACKGROUND: To evaluate the prognostic value of frailty in older recipients of concomitant valve replacement (VR) and bipolar radiofrequency ablation (BRFA), we examined whether clinical and functional outcomes differed between frail and non-frail groups of older patients referred for concomitant VR and BRFA. METHODS: In a single-center retrospective observational cohort study, we compared the clinical and functional outcomes in frail versus non-frail patients. Frailty was assessed using the 5-item Cardiovascular Health Study (CHS) frailty scale. Patients were divided into two groups, frail and non-frail. Functional outcome was assessed using the internationally validated Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire. RESULTS: We enrolled 185 patients aged ≥ 65 years who underwent concomitant VR and BRFA. About 36.2% (n = 67) of the patients were included in the frail group and the remaining patients (n = 118) in the non-frail group. Follow-up was complete with a median duration of 58 months (interquartile range 44-76 months). Significant differences were observed between the two groups with respect to postoperative pulmonary complications (frail vs. non-frail patients, 50.74% vs. 22.9%, respectively, P < .001) and hospital mortality (10.45% vs. 1.69%, respectively, P = .021). The frail group had a higher adjusted risk for all-cause mortality (adjusted HR 4.06; 95% CI 1.33 to 12.38; P = .014) and all-cause hospitalization (adjusted HR 2.24; 95% CI 1.12 to 4.50; P = .023). Frailty was associated with lower overall AFEQT scores at baseline (Estimate, - 0.400; 95% CI - 0.532 to - 0.267; P < .001). Compared to the non-frail group, the frail group continued to have lower overall AFEQT scores with no significant improvement in follow-up at 1 year and 2 years after concomitant VR and BRFA. CONCLUSION: Frail patients had lower baseline AFEQT scores and were more likely to have adverse outcomes from postoperative pulmonary complications, and frailty was also an independent risk factor for long-term all-cause mortality and all-cause rehospitalization. Further studies are needed to assess the impact of frailty.
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Lin et al. (2022) conducted a cohort in Valvular heart disease with atrial fibrillation (n=185). Frailty vs. Non-frail was evaluated on All-cause mortality during follow-up (HR 4.06, 95% CI 1.33 to 12.38, p=0.014). Frailty was associated with a significantly higher risk of long-term all-cause mortality (adjusted HR 4.06) compared to non-frail patients undergoing concomitant valve replacement and ablation.
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