Author + information
- Jay Patel1,
- Sandeep Banga2,
- Min-Chul Kim3,
- Keattiyoat Wattanakit4,
- Marco A. Barzallo5 and
- Sudhir Mungee6
Frailty, as a syndrome, is being recognized as having an important influence on the overall health and prognosis for older patients, especially those undergoing transcatheter aortic valve replacement (TAVR). However, the impact of frailty on cost for TAVR is unknown.
We retrospectively collected data on all adult patients who underwent TAVR from December 2012 to September 2015 at our tertiary medical center. Patients whose TAVR was aborted or who died from an immediate complication of the TAVR were excluded. We used gait speed (≥6s or inability to walk on 5-Meter Walk Test) and serum albumin (<3.5g/dL) as indices of impaired mobility and malnutrition, respectively, to define a composite frailty profile. Cost data was obtained with the assistance of OSF Ministry Healthcare Analytics. Univariate and multivariate analyses were performed to adjust for age, gender, BMI, comorbidities, STS score, pre-TAVR KCCQ12 score, year TAVR was performed, and femoral approach.
Of the total 134 patients, 117 patients met inclusion/exclusion criteria and were assessed for frailty (age: 83±7.5yrs, male: 66 (56.4%), BMI: 28 ± 5.7, Society of Thoracic Surgeons Risk Score: 7.96 ± 5.3). 31 (26.5%) patients had a composite frailty profile. Co-morbidities between frail and non-frail patients were similar, except for a higher incidence of atrial fibrillation (61.3% vs. 34.9%, p=0.011). In a generalized linear model, frailty profile was independently associated with a higher cost after TAVR, on average $10,033 per frail patient ($64,994 vs. $54,960, p=0.001). This was primarily driven by a greater number of ICU days (2.7 vs. 0.5 days, p=0.001) and longer hospital length of stay (9.0 vs 3.5 days, p<0.001). In addition, frail patients were more likely to require post-acute care (48.4% vs. 25.6%, p=0.024) and have a longer TAVR-to-home time (HR=0.50, 95% CI: (0.28, 0.91), p=0.023).
Impaired mobility and malnutrition were independently associated with higher total cost in patients undergoing TAVR. Further studies are warranted to identify strategies that optimize the frailty profile and reduce the total cost for patients undergoing TAVR.
STRUCTURAL: Valvular Disease: Aortic