👤 Authors: Clemens Metze, Elric Zweck, Christos Iliadis, Maria Isabel Körber, Matthieu Schäfer, Ralf Westenfeld, Amin Polzin, Marcel Halbach, Stephan Baldus, Roman Pfister
A Simplified Frailty Measure Improves Risk Stratification in Patients Undergoing Percutaneous Mitral Valve Repair.
OBJECTIVE
The aim of this study was to examine frailty measures for risk prediction in patients undergoing percutaneous mitral valve repair (PMVR).
BACKGROUND
Performance of current risk prediction models based on organ morbidity is only moderate.
METHODS
The frailty domains exhaustion, slowness, inactivity, weakness, and unintentional weight loss were prospectively assessed in patients undergoing PMVR. The association with mortality and heart failure hospitalization (HFH) during a median follow-up of 506 days was examined and relevant domains were assessed for additive predictive performance over the MitraScore.
RESULTS
Five hundred twenty-four patients were included in the study (mean age [SD]: 77 (9) years, 54.6% male).
The risk of mortality and mortality/HFH were significantly increased in patients with exhaustion (hazard ratio: 2.24 [95% CI: 1.63-3.08]/1.83 [1.21-2.77]), slowness (2.74 [1.75-4.30]/1.92 [1.34-2.75]), inactivity (1.96 [1.26-3.05]/1.61 [1.12-2.31]) and weakness (1.83 [1.12-2.96]/1.34 [0.92-1.95]), but not in patients with weight loss (1.24 [0.80-1.92]/1.12 [0.78-1.61]). A simplified frailty (S-frailty) measure derived from the domains exhaustion and slowness was associated with mortality (4.45 [2.42-8.19]) and mortality/HFH (2.60 [1.64-4.13]) independently of clinical risk factors and the MitraScore, respectively.
Prediction of mortality by the MitraScore was significantly improved when adding S-frailty (Harrell’s C 0.645 vs. 0.700, p = 0.002). Classification of 1-year mortality risk by the MitraScore improved when adding S-frailty (net reclassification index 0.21, p = 0.012 and integrated discrimination index 0.07, p < 0.001).
CONCLUSIONS
A simplified frailty measure comprising self-reported exhaustion and gait speed significantly improved risk prediction in patients undergoing PMVR.
Assessment of frailty measures should be part of the decision-making process and multiparametric risk scores in patients with severe mitral regurgitation.
