A higher claims-based frailty index (tertile 3 vs 1) was associated with an increased risk of 1-year all-cause mortality (31.3% vs 19.3%; HR 1.73; 95% CI 1.41-2.12; P<0.001) in aortic valve disease.
Observational (n=2,357)
Yes
Does a higher claims-based frailty index predict increased mortality and adverse events in older adults with aortic valve disease?
A claims-based frailty index can validly identify frailty status and predict mortality and adverse events in older adults with aortic valve disease when in-person assessments are unavailable.
Effect estimate: HR 1.73 (95% CI 1.41-2.12)
Absolute Event Rate: 31.3% vs 19.3%
p-value: p=<0.001
Background In aortic valve disease, the relationship between claims‐based frailty indices (CFIs) and validated measures of frailty constructed from in‐person assessments is unclear but may be relevant for retrospective ascertainment of frailty status when otherwise unmeasured. Methods and Results We linked adults aged ≥65 years in the US CoreValve Studies (linkage rate, 67%; mean age, 82.7±6.2 years, 43.1% women), to Medicare inpatient claims, 2011 to 2015. The Johns Hopkins CFI, validated on the basis of the Fried index, was generated for each study participant, and the association between CFI tertile and trial outcomes was evaluated as part of the EXTEND‐FRAILTY substudy. Among 2357 participants (64.9% frail), higher CFI tertile was associated with greater impairments in nutrition, disability, cognition, and self‐rated health. The primary outcome of all‐cause mortality at 1 year occurred in 19.3%, 23.1%, and 31.3% of those in tertiles 1 to 3, respectively (tertile 2 versus 1: hazard ratio, 1.22; 95% CI, 0.98–1.51; P =0.07; tertile 3 versus 1: hazard ratio, 1.73; 95% CI, 1.41–2.12; P <0.001). Secondary outcomes (bleeding, major adverse cardiovascular and cerebrovascular events, and hospitalization) were more frequent with increasing CFI tertile and persisted despite adjustment for age, sex, New York Heart Association class, and Society of Thoracic Surgeons risk score. Conclusions In linked Medicare and CoreValve study data, a CFI based on the Fried index consistently identified individuals with worse impairments in frailty, disability, cognitive dysfunction, and nutrition and a higher risk of death, hospitalization, bleeding, and major adverse cardiovascular and cerebrovascular events, independent of age and risk category. While not a surrogate for validated metrics of frailty using in‐person assessments, use of this CFI to ascertain frailty status among patients with aortic valve disease may be valid and prognostically relevant information when otherwise not measured.
Strom et al. (Wed,) conducted a observational in Aortic valve disease (n=2,357). Claims-based frailty index (CFI) tertile 3 vs. CFI tertile 1 was evaluated on All-cause mortality at 1 year (HR 1.73, 95% CI 1.41-2.12, p=<0.001). A higher claims-based frailty index (tertile 3 vs 1) was associated with an increased risk of 1-year all-cause mortality (31.3% vs 19.3%; HR 1.73; 95% CI 1.41-2.12; P<0.001) in aortic valve disease.
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