• Wien. Klin. Wochenschr. · Dec 2023

    Observational Study

    Frailty as a predictor of mortality and readmission rate in secondary mitral regurgitation.

    • Robert Uzel, Richard Rezar, Raphael Romano Bruno, Sarah Wernly, Christian Jung, Georg Delle Karth, Christian Datz, Friedrich Hoppichler, and Bernhard Wernly.
    • Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020, Salzburg, Austria. robert.uzel@bbsalz.at.
    • Wien. Klin. Wochenschr. 2023 Dec 1; 135 (23-24): 696702696-702.

    IntroductionSelection in patients with functional mitral regurgitation (MR) to identify responders to interventions is challenging. In these patients, frailty might be used as a multidimensional parameter to summarize the resilience to stressors. Our objective was to evaluate frailty as a predictor of outcome in patients with moderate to severe secondary MR.MethodsWe conducted a single-center retrospective observational cohort study and included 239 patients with moderate to severe secondary MR aged 65 years or older between 2014 and 2020. Echocardiography was performed at baseline; frailty was evaluated using the clinical frailty scale (CFS). The combined primary endpoint was hospitalization for heart failure and all-cause mortality.ResultsA total of 53% (127) of all patients were classified as CFS 4 (living with mild frailty) or higher. Frail patients had a higher risk for the combined endpoint (hazard ratio, HR 3.70, 95% confidence interval, CI 2.12-6.47; p < 0.001), 1‑year mortality (HR 5.94, 95% CI 1.76-20.08; p < 0.001) even after adjustment for EuroSCORE2. The CFS was predictive for the combined endpoint (AUC 0.69, 95% CI 0.62-0.75) and outperformed EuroSCORE2 (AUC 0.54, 95% CI 0.46-0.62; p = 0.01). In sensitivity analyses, we found that frailty was associated with adverse outcomes at least in trend in all subgroups.ConclusionFor older, medically treated patients with moderate to severe secondary mitral regurgitation, frailty is an independent predictor for the occurrence of death and heart failure-related readmission within 1 year and outperformed the EuroSCORE2. Frailty should be assessed routinely in patients with heart failure to guide clinical decision making for mitral valve interventions or conservative treatment.© 2023. The Author(s).

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