Abstract 370: Trends, Incidence and In-hospital Outcomes of Frailty Among Patients Hospitalized for Transcatheter Aortic Valve Replacement in The United State

Background: Transcatheter aortic valve replacement (TAVR) is a relatively safe procedure and is fast becoming the preferred approach for aortic valve replacement in low risk patients. Although frail patients who pose high surgical risk may benefit from TAVR, little is known about the trends and outcomes of TAVR in frail patients admitted for TAVR. We sought to describe the trend, incidence and in-hospital outcomes of frailty in patients hospitalized for TAVR. Methods: We utilized the National Inpatient Sample database to identify patients admitted for TAVR between January 1, 2010 to December 31, 2014. We identified frail patients using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. We used the appropriate ICD-9-CM codes to identify the diagnoses. Proportions and frequencies were generated for categorical variables and differences were reported using the chi square test. We used student’s t-test to analyze differences in means for continuous variable. Predictors of frailty and mortality were assessed using logistic regression. Results: Of the 42243 TAVR admissions, 3.8% were identified as frail based on the John Hopkins' ACG frailty defining indicators. There is an increasing trend of TAVR use in frail patients from 2.1% in 2011 to 3.8% in 2014 of all the TAVR admissions (P trend =0.000). Predictors of frailty include older age group(aOR 1.65 95% CI 1.12-2.44 for age more than 80years compared to 18-64years), female sex(aOR 1.20 95% CI 1.07-1.35), depression (aOR 1.50 95% CI 1.23-1.82), complicated diabetes(aOR 1.47 95% CI 1.16-1.86) and significant weight loss (aOR 16.37 95% CI 14.41-18.60). Compared to non-frail patients, frail patients had a higher likelihood of in-hospital mortality (8.8% compared to 4.0% p=0.000), longer hospital stay (13.65±11.65 compared to 7.85±6.99 days in non-frail patients). Conclusion: Frailty is associated with poorer outcomes in patients hospitalized for TAVR in the United States. Identification of predisposing factors to frailty and optimization of these factors when possible may help reduce adverse outcomes in this patient population. More studies are needed to clearly elucidate the effect of frailty on TAVR outcomes.