Identification of Frailty Using a Claims‐Based Frailty Index in the CoreValve Studies: Findings from the EXTEND‐FRAILTY Study
Background In aortic valve disease, the relationship between claims‐based frailty indices (CFIs) and validated measures of frailty constructed from in‐person assessments is unclear but may be relevant for retrospective ascertainment of frailty status when otherwise unmeasured. Methods and Results We...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.022150 |
| _version_ | 1797936116651786240 |
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| author | Jordan B. Strom Jiaman Xu Ariela R. Orkaby Changyu Shen Brian R. Charest Dae H. Kim David J. Cohen Daniel B. Kramer John A. Spertus Robert E. Gerszten Robert W. Yeh |
| author_facet | Jordan B. Strom Jiaman Xu Ariela R. Orkaby Changyu Shen Brian R. Charest Dae H. Kim David J. Cohen Daniel B. Kramer John A. Spertus Robert E. Gerszten Robert W. Yeh |
| author_sort | Jordan B. Strom |
| collection | DOAJ |
| description | Background In aortic valve disease, the relationship between claims‐based frailty indices (CFIs) and validated measures of frailty constructed from in‐person assessments is unclear but may be relevant for retrospective ascertainment of frailty status when otherwise unmeasured. Methods and Results We linked adults aged ≥65 years in the US CoreValve Studies (linkage rate, 67%; mean age, 82.7±6.2 years, 43.1% women), to Medicare inpatient claims, 2011 to 2015. The Johns Hopkins CFI, validated on the basis of the Fried index, was generated for each study participant, and the association between CFI tertile and trial outcomes was evaluated as part of the EXTEND‐FRAILTY substudy. Among 2357 participants (64.9% frail), higher CFI tertile was associated with greater impairments in nutrition, disability, cognition, and self‐rated health. The primary outcome of all‐cause mortality at 1 year occurred in 19.3%, 23.1%, and 31.3% of those in tertiles 1 to 3, respectively (tertile 2 versus 1: hazard ratio, 1.22; 95% CI, 0.98–1.51; P=0.07; tertile 3 versus 1: hazard ratio, 1.73; 95% CI, 1.41–2.12; P<0.001). Secondary outcomes (bleeding, major adverse cardiovascular and cerebrovascular events, and hospitalization) were more frequent with increasing CFI tertile and persisted despite adjustment for age, sex, New York Heart Association class, and Society of Thoracic Surgeons risk score. Conclusions In linked Medicare and CoreValve study data, a CFI based on the Fried index consistently identified individuals with worse impairments in frailty, disability, cognitive dysfunction, and nutrition and a higher risk of death, hospitalization, bleeding, and major adverse cardiovascular and cerebrovascular events, independent of age and risk category. While not a surrogate for validated metrics of frailty using in‐person assessments, use of this CFI to ascertain frailty status among patients with aortic valve disease may be valid and prognostically relevant information when otherwise not measured. |
| first_indexed | 2024-04-10T18:24:44Z |
| format | Article |
| id | doaj.art-9548756a277941bfb0545380161020ca |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T18:24:44Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-9548756a277941bfb0545380161020ca2023-02-02T06:18:44ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-10-01101910.1161/JAHA.121.022150Identification of Frailty Using a Claims‐Based Frailty Index in the CoreValve Studies: Findings from the EXTEND‐FRAILTY StudyJordan B. Strom0Jiaman Xu1Ariela R. Orkaby2Changyu Shen3Brian R. Charest4Dae H. Kim5David J. Cohen6Daniel B. Kramer7John A. Spertus8Robert E. Gerszten9Robert W. Yeh10Department of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MARichard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MAHarvard Medical School Boston MARichard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MAHarvard Medical School Boston MAHarvard Medical School Boston MACardiovascular Research Foundation New York NYDepartment of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MASection of Cardiovascular Disease University of Missouri‐Kansas City School of Medicine Kansas City MODepartment of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MADepartment of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MABackground In aortic valve disease, the relationship between claims‐based frailty indices (CFIs) and validated measures of frailty constructed from in‐person assessments is unclear but may be relevant for retrospective ascertainment of frailty status when otherwise unmeasured. Methods and Results We linked adults aged ≥65 years in the US CoreValve Studies (linkage rate, 67%; mean age, 82.7±6.2 years, 43.1% women), to Medicare inpatient claims, 2011 to 2015. The Johns Hopkins CFI, validated on the basis of the Fried index, was generated for each study participant, and the association between CFI tertile and trial outcomes was evaluated as part of the EXTEND‐FRAILTY substudy. Among 2357 participants (64.9% frail), higher CFI tertile was associated with greater impairments in nutrition, disability, cognition, and self‐rated health. The primary outcome of all‐cause mortality at 1 year occurred in 19.3%, 23.1%, and 31.3% of those in tertiles 1 to 3, respectively (tertile 2 versus 1: hazard ratio, 1.22; 95% CI, 0.98–1.51; P=0.07; tertile 3 versus 1: hazard ratio, 1.73; 95% CI, 1.41–2.12; P<0.001). Secondary outcomes (bleeding, major adverse cardiovascular and cerebrovascular events, and hospitalization) were more frequent with increasing CFI tertile and persisted despite adjustment for age, sex, New York Heart Association class, and Society of Thoracic Surgeons risk score. Conclusions In linked Medicare and CoreValve study data, a CFI based on the Fried index consistently identified individuals with worse impairments in frailty, disability, cognitive dysfunction, and nutrition and a higher risk of death, hospitalization, bleeding, and major adverse cardiovascular and cerebrovascular events, independent of age and risk category. While not a surrogate for validated metrics of frailty using in‐person assessments, use of this CFI to ascertain frailty status among patients with aortic valve disease may be valid and prognostically relevant information when otherwise not measured.https://www.ahajournals.org/doi/10.1161/JAHA.121.022150aortic valve diseaseclaimsfrailtySAVRTAVR |
| spellingShingle | Jordan B. Strom Jiaman Xu Ariela R. Orkaby Changyu Shen Brian R. Charest Dae H. Kim David J. Cohen Daniel B. Kramer John A. Spertus Robert E. Gerszten Robert W. Yeh Identification of Frailty Using a Claims‐Based Frailty Index in the CoreValve Studies: Findings from the EXTEND‐FRAILTY Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic valve disease claims frailty SAVR TAVR |
| title | Identification of Frailty Using a Claims‐Based Frailty Index in the CoreValve Studies: Findings from the EXTEND‐FRAILTY Study |
| title_full | Identification of Frailty Using a Claims‐Based Frailty Index in the CoreValve Studies: Findings from the EXTEND‐FRAILTY Study |
| title_fullStr | Identification of Frailty Using a Claims‐Based Frailty Index in the CoreValve Studies: Findings from the EXTEND‐FRAILTY Study |
| title_full_unstemmed | Identification of Frailty Using a Claims‐Based Frailty Index in the CoreValve Studies: Findings from the EXTEND‐FRAILTY Study |
| title_short | Identification of Frailty Using a Claims‐Based Frailty Index in the CoreValve Studies: Findings from the EXTEND‐FRAILTY Study |
| title_sort | identification of frailty using a claims based frailty index in the corevalve studies findings from the extend frailty study |
| topic | aortic valve disease claims frailty SAVR TAVR |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.022150 |
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