Effectiveness of Valvular Surgery Based on Frailty Risk in Patients with Infective Endocarditis
07/17/2024
The following is a summary of “Impact of valvular surgery according to frailty risk in patients with infective endocarditis,” published in the May 2024 issue of Cardiology by Diaz-Arocutipa et al.
Valvular surgery might lower death rates in some patients with infective endocarditis (IE), but how well it works for frail patients isn’t clear.
Researchers conducted a retrospective study to understand how valvular surgery affects patients with IE based on their frailty levels.
They used the National Inpatient Sample data between 2016 and 2019. Adult patients with diagnosed IE were included, and frailty was measured with the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between the groups.
The results showed that 53,275 patients with IE were included, and 18.3% had valvular surgery. Median age was 52 (34-68) years, with 41% females. Frailty risk: 42.7% low, 53.1% intermediate, 4.2% high. After IPTW, in-hospital mortality was similar overall (3.7% vs. 4.1%, P=0.483) and low (1% vs. 0.9%, P=0.952) and moderate (5.4% vs. 6%, P=0.548) risk of frailty. High-risk frailty patients had lower mortality with surgery (4.6% vs. 13.9%, P=0.16). Renal replacement therapy was similar, but surgery increased mechanical circulatory support and pacemaker implantation use.
Investigators concluded that survival was similar for patients with low or intermediate frailty risk, whether they had valve surgery or medical management. However, valve surgery was associated with better survival outcomes for high-risk individuals.