Background

Frailty is a known predictor of periprocedural complications and recovery after cardiovascular interventions. Its impact on in-hospital outcomes in patients undergoing TAVR is not well studied. We conducted a study using National Inpatient Sample (NIS) database to assess the effect of frailty on in-hospital outcomes in patients after Endovascular TAVR (EV-TAVR).

Methods

The NIS database was queried from Jan 2012 to Sep 2015 to identify patients≥ 18 years undergoing EV-TAVR using ICD9 code. Frailty was defined based on the 10 clusters of frailty-defining diagnoses that comprise the Johns Hopkins adjusted clinic groups frailty-defining diagnosis indicator. Outcomes included in-hospital mortality, vascular complications, cardiac complications and major bleeding or need for transfusion (BT) among others (Table 1). Multivariate logistic regression was used to examine the association of frailty with these outcomes.

Results

Of the 51865 patients undergoing EV-TAVR, 5.5% were frail. Frailty was associated with higher in-hospital mortality (adjusted OR 1.66; 95% CI 1.35-2.06; p< 0.001). Vascular and major bleeding complications (including BT) were also higher in frail patients, even after adjustment.

Conclusion

Frail patients have 3-fold higher in-hospital mortality compared to non-frail patients along with higher odds of vascular and bleeding complications. Further studies will help better select the patients who benefit from therapeutic effect of TAVR with improved outcomes.