Frailty, clinical outcomes, and cost in patients undergoing trans-catheter aortic valve implantation (TAVI)
Abstract
The objective of this doctoral was three-fold: 1) to systematically review frailty measures and prognosis of frail patients undergoing TAVI, 2) to examine the performance of frailty indices in predicting clinical outcomes after TAVI, and 3) to examine the performance of frailty indices in predicting one-year costs of TAVI and high-cost TAVI patients.
For the first objective, we systematically reviewed the literature published in 2006 or later. We found that frailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity.
For the second objective, we utilized data from the CorHealth Ontario TAVI registry and administrative databases housed at the Institute for Clinical Evaluative Sciences (IC/ES), Canada. Two administrative database frailty indices, the Johns Hopkins Adjusted Clinical Group (ACG) frailty indicator and the Hospital Frailty Risk Score (HFRS), were used to assign frailty status. We found that the agreement between the Johns Hopkins ACG frailty indicator and the HFRS was fair. Both the Johns Hopkins ACG frailty indicator and the HFRS were significantly associated with one-year mortality and rehospitalization following TAVI. We found that both the Johns Hopkins ACG frailty indicator and HFRS improved performance in predicting one-year mortality and rehospitalization.
For the third objective, we analyzed cost data from the same Ontario TAVI cohort. We found that frail patients incurred significantly increased one-year healthcare costs. The HFRS was a significant predictor for high-cost patients. We found that the HFRS improved the performance of the model in predicting high-cost patients.