TY - JOUR
T1 - Impact of valvular surgery according to frailty risk in patients with infective endocarditis
AU - Diaz-Arocutipa, Carlos
AU - Moreno, Guillermo
AU - Vicent, Lourdes
N1 - Publisher Copyright:
© 2024 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
PY - 2024/5
Y1 - 2024/5
N2 - Background: Observational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population. Methods: We performed a retrospective study using the 2016−2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups. Results: A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34−68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in-hospital mortality was similar both for the entire cohort between valvular and non-valvular surgery groups (3.7% vs. 4.1%, p =.483), and low (1% vs. 0.9%, p =.952) or moderate (5.4% vs. 6%, p =.548) risk of frailty. However, patients at high risk of frailty had significantly lower in-hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p =.016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation. Conclusions: Our findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high-risk individuals.
AB - Background: Observational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population. Methods: We performed a retrospective study using the 2016−2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups. Results: A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34−68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in-hospital mortality was similar both for the entire cohort between valvular and non-valvular surgery groups (3.7% vs. 4.1%, p =.483), and low (1% vs. 0.9%, p =.952) or moderate (5.4% vs. 6%, p =.548) risk of frailty. However, patients at high risk of frailty had significantly lower in-hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p =.016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation. Conclusions: Our findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high-risk individuals.
KW - frailty
KW - infective endocarditis
KW - mortality
KW - valvular surgery
UR - http://www.scopus.com/inward/record.url?scp=85192884404&partnerID=8YFLogxK
U2 - 10.1002/clc.24268
DO - 10.1002/clc.24268
M3 - Artículo
C2 - 38741388
AN - SCOPUS:85192884404
SN - 0160-9289
VL - 47
JO - Clinical Cardiology
JF - Clinical Cardiology
IS - 5
M1 - e24268
ER -