Universität zu Köln

Metze, Clemens, Matzik, Anna-Sophie, Scherner, Maximilian, Koerber, Maria Isabel, Michels, Guido, Baldus, Stephan, Rudolph, Volker and Pfister, Roman (2017). Impact of Frailty on Outcomes in Patients Undergoing Percutaneous Mitral Valve Repair. JACC-Cardiovasc. Interv., 10 (19). S. 1920 - 1930. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1876-7605

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Abstract

OBJECTIVES The aim of this study was to describe the impact of frailty in patients undergoing percutaneous mitral valve repair (PMVR). BACKGROUND Frailty is common in elderly patients and those with comorbidities and is associated with adverse prognosis. METHODS Frailty according to the Fried criteria was assessed in consecutive patients admitted for PMVR. Associations of frailty with 6-week (device success, changes in 6-min walking distance and Minnesota Living With Heart Failure Questionnaire and Short Form 36 physical and mental component scores, and improvement >= 1 New York Heart Association functional class) and long-term outcomes during a median follow-up period of 429 days were examined. RESULTS Of 213 patients admitted for PMVR (median age 78 years; age range 50 to 95 years; 57.3% men), 45.5% were classified as frail. Compared with nonfrail patients, frail patients had a similar device success rate (81.4% vs. 84.5%; p = 0.56) and improvement in 6-min walking distance, New York Heart Association functional class, and Short Form-36 scores but a more pronounced improvement in Minnesota Living With Heart Failure Questionnaire score (mean change = 15.9 vs. = 11.2 points; p = 0.002). Mortality at 6 weeks was significantly higher in frail (8.3%) compared with nonfrail (1.7%) patients (p = 0.03). Hazards of death (hazard ratio: 3.06; 95% confidence interval: 1.54 to 6.07; p = 0.001) and death or heart failure decompensation (hazard ratio: 2.03; 95% confidence interval: 1.22 to 3.39; p = 0.007) were significantly increased in frail patients during long-term follow-up, which did not change relevantly after adjustment for European System for Cardiac Operative Risk Evaluation score and N-terminal pro-brain natriuretic peptide level. CONCLUSIONS PMVR can be performed with equal efficacy and is associated with at least similar short-term functional improvement in frail patients. These results support the continued use of PMVR in frail elderly patients with the goal of palliation of heart failure symptoms and improvement in quality of life. (C) 2017 by the American College of Cardiology Foundation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Metze, Clemens UNSPECIFIED UNSPECIFIED UNSPECIFIED Matzik, Anna-Sophie UNSPECIFIED UNSPECIFIED UNSPECIFIED Scherner, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Koerber, Maria Isabel UNSPECIFIED UNSPECIFIED UNSPECIFIED Michels, Guido UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-214439
DOI:	10.1016/j.jcin.2017.07.042
Journal or Publication Title:	JACC-Cardiovasc. Interv.
Volume:	10
Number:	19
Page Range:	S. 1920 - 1930
Date:	2017
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1876-7605
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language VALVULAR HEART-DISEASE; SURGICAL RISK PATIENTS; QUALITY-OF-LIFE; ELDERLY-PATIENTS; EUROPEAN ASSOCIATION; OLDER-ADULTS; REGURGITATION; PREDICTORS; MANAGEMENT; MORTALITY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21443