OR03-8
National Trends in Transcatheter Aortic Valve Replacement Across Frailty Class
Presenter
Tanya Sharma, MBBS, Westchester Medical Center, White Plains, NY
Tanya Sharma, MBBS1, Somar Hadid2, Akiva Rosenzveig, BA2, Rahul Gupta, MBBS3, Aaqib H Malik, MD MPH4 and Hasan A. Ahmad, M.D.5, (1)Westchester Medical Center, White Plains, NY, (2)New York Medical College, Teaneck, NJ, (3)Lehigh Valley Health Network, Macungie, PA, (4)Westchester medical center, Valhalla, NY, (5)New York Medical College, Brooklyn, NY
Keywords: TAVI/TAVR/Aortic Valve
Background
As recommendations for Transcatheter aortic valve replacement (TAVR) expand, more patients across the spectrum of frailty will now undergo the procedure. It is important to evaluate characteristics and outcomes across the frailty spectrum.
Methods
The National Inpatient Sample (NIS) database was queried from 2012-2020 to identify hospitalizations with ICD-10 revision procedural codes for TAVR. Patients were categorized based on hospital frailty risk score (HFRS) into 3 categories of low (HFRS≤4), intermediate (HFRS 5 to 15) and high frailty (HFRS>15). Patient characteristics and in-hospital outcomes were evaluated over time across the three categories. Baseline characteristics were compared using Pearson chi-square test or Fisher exact test for categorical variables, or Kruskal-Wallis H test for continuous variables. Cochran-Armitage test was used to evaluate trends. Logistic regression models were created to identify association of HFRS categories with outcomes, and are reported as adjusted odds ratio (aOR) with 95% confidence intervals (CI). Statistical analyses were performed using STATA 16.1. Results
We identified 366,990 hospitalizations for TAVR from 2012 to 2020. On multivariable logistic regression, high frailty was associated with increased odds of in-hospital mortality [13.8 (9.91-19.25), p<0.001], transfusion [5.23 (4.21-6.48), p<0.001], and increased length of stay (LOS) [13.86 (12.60-15.07), p<0.001], when compared to the low frailty group. Complications such as ventilator use [0.9% vs 8.8% vs 28.2%, p<0.001], AKI [3.7% vs 31.1% vs 67%, p<0.001], stroke [0.6% vs 3.2% vs 17.1%, p<0.001], pacemaker [8.7% vs 12.8% vs 13.9%, p<0.001], sepsis [0.1% vs 3.5% vs 18.5%, p<0.001] increased progressively with each elevated frailty cohort.
Conclusions
Despite increasing operator experience and improved device platforms, patients in the highest frailty subgroup continue to have significant morbidity and mortality. Assessment of frailty may be one of the most parameters of risk assessment in patients undergoing TAVR.