Author + information
- Mike Saji1,
- Ryosuke Higuchi1,
- Kenichi Hagiya2,
- Itaru Takamisawa1,
- Tetsuya Tobaru1,
- Nobuo Iguchi1,
- Shuichiro Takanashi2,
- Morimasa Takayama2 and
- Mitsuaki Isobe1
Frailty has become a major theme in cardiovascular diseases due to the aging population. Recently, variable frailty markers have been developed to guide better patient selection in transcatheter aortic valve implantation (TAVI). This study aimed to investigate the timing, and specific causes of unplanned hospital readmission after initial hospitalization with TAVI, and to investigate which frailty markers could better predict unplanned readmission.
We retrospectively reviewed 155 patients who underwent TAVI. Although unplanned readmission <30days was 1.9%, quarter of patients had unplanned readmission following TAVI within a year mainly due to heart failure and pneumonia. Short physical-performance battery (SPPB), Placement of AoRTic TraNscathetER Valve (PARTNER) frailty scale, frailty index, clinical frailty scale, modified Fried scale, and gait speed were calculated. The primary endpoints was unplanned hospital readmission following TAVI. Each frailty marker was entered into a multivariate model in addition to variables with p-values <0.25 in a univariate analysis.
With 479 ± 319 days, 64 (41%) patients had unplanned readmission following TAVI. Only three patients (1.9%) required unplanned readmission less than 30 days. Of 64 admissions, 27 were due to cardiac causes, while 37 were noncardiac causes. Of 27 admissions with cardiac reason, 16 (59%) were due to heart failure, while 37 admissions with noncardiac reason, 21 (56%) were due to infection. All frailty markers but the modified Fried scale were found to be independently associated with primary endpoints after adjustment in multivariate analysis. Other independent predictors in multivariate analysis were atrial fibrillation, chronic obstructive pulmonary disease, hemoglobin <11g/dL, estimated gromerular filtration rate (every 15 ml/1.73m2 decrease), and albumin. Furthermore, in receiver operating characteristic analysis, the SPPB had the highest discriminatory performance for predicting primary endpoint (area under the curve 0.71, 95% confidence interval 0.60–0.80, p <0.001).
Precise geriatric assessment is crucial following TAVI as well as index hospitalization in this frail population.
STRUCTURAL: Valvular Disease: Aortic