Nav: Home

Frailty may be highly predictive of complications, death in patients with mitral valve disease

March 19, 2020

CHICAGO (March 19, 2020) -- Frailty measurements have become increasingly important in assessing surgical risk in patients with mitral valve disease, and research published online today in the Annals of Thoracic Surgery shows that frailty plays a significant role in outcomes following mitral valve procedures.

"Frailty correlates with mortality and length of hospital stay, as well as with more readmissions after mitral valve surgery. Underappreciated is the effect that frailty has on readmission burden after surgical interventions," said Amit Iyengar, MD, MSE, from Penn Medicine in Philadelphia.

Dr. Iyengar and colleagues from Penn Medicine, examined data from the National Readmissions Database (NRD)--an archive that includes discharge information from hospitals across more than 20 states and is helpful in estimating immediate outcomes after surgery. The researchers identified 102,114 adult patients who underwent mitral valve replacement surgery between 2010 and 2014. After various exclusion criteria were applied, 50,410 patients composed the final study group. Among these patients, frailty was present in 7.9%.

The researchers found that frail patients were more likely to experience complications after surgery (76.7% vs. 46.6%), be discharged to a destination other than home (49.8% vs. 20.5%), be readmitted to the hospital within 30 days (27% vs. 19.8%), and experience in-hospital mortality (11.6% vs. 3.9%). In addition, the length of initial hospital stay was significantly longer among frail patients, with 23 days for frail patients vs. 9 days for non-frail patients.

Overall, the study showed that readmission was approximately 30% for frail patients (most often for heart failure) and 20% for non-frail patients, and the cost of hospitalization was nearly double for frail patients--$91,081 vs. $47,899.

He said this study suggests that frailty screening may help better risk-stratify patients before mitral valve surgery because frailty compromises the body's ability to cope with stressors such as surgery; yet clear/definitive standards for evaluating and treating frailty before surgery do not exist. Frailty sometimes is measured by a patient's grip strength, weight, activity level, and walking test results.

"Frailty is a hot topic and we feel confident that with further study and discussion among surgeons, we as a community can arrive at a consensus method for assessing frailty that could then be adopted widely," said Dr. Iyengar.

In the meantime, surgeons have done an "excellent job" of incorporating this relatively new concept of frailty into their work-ups and discussions with patients before surgery, noted Dr. Iyengar. "Careful consideration of frailty is an important step in preoperative risk assessment and shared decision-making for patients with mitral valve disease. Frailty should be part of the discussions between patients, cardiologists, and surgeons regarding what to expect from mitral valve surgery, what the risks of surgery might be, and how to counsel patients and families before and after surgery," he said.
-end-
Iyengar A, Goel N, Kelly JJ, Han J, Brown CR, Khurshan F, Chen Z, and Desai N. Effects of Frailty on Outcomes and 30-day Readmissions After Surgical Mitral Valve Replacement. DOI: 10.1016/j.athoracsur.2019.10.087.

Find comprehensive medical information presented for patients by leading experts in cardiothoracic surgery on the STS Patient Website (ctsurgerypatients.org). For a copy of The Annals article, contact Jennifer Bagley at 312-202-5865 or jbagley@sts.org.

Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing 7,500 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society's mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association. It has an impact factor of 3.919.

The Society of Thoracic Surgeons

Related Mortality Articles:

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.
Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.
What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.
COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.
COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.
Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.
Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.
Examining the link between caste and under-five mortality in India
In India, children that belong to disadvantaged castes face a much higher likelihood of not living past their fifth birthday than their counterparts in non-deprived castes.
Mortality rates rising for Gens X and Y too
Declining life expectancies in the US include Gen X and Y Americans, in addition to the older Baby Boomers.
Trust in others predicts mortality in the United States
Do you trust other people? It may prolong your life.
More Mortality News and Mortality Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at Radiolab.org/donate.