Frailty and Related Outcomes in Patients Undergoing Transcatheter Valve Therapies
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CitationKundi, Harun. 2019. Frailty and Related Outcomes in Patients Undergoing Transcatheter Valve Therapies. Master's thesis, Harvard Medical School.
AbstractAs the population ages, understanding the relationship between frailty, a syndrome involving multisystem impairment in functional recovery, and outcomes is increasingly important to accurately predict healthcare utilization and adverse outcomes. The addition of frailty to risk models is also important to ensure adequate risk-adjustment. National guidelines strongly recommend an objective evaluation of frailty to optimize patient selection, but the range of available measures raises issues with consistency. In clinical practice, frailty is not often measured due to the lack of consensus surrounding frailty assessment tools, and there are divergent prevalence estimates and effect sizes reported across different studies. Furthermore, the prospective collection of information on frailty is time-consuming and may not always be feasible. In addition, registries may misrepresent frailty status and prevalence by focusing on a limited definition of frailty, not including all hospitals, and defining frailty according to a single point in time.
Administrative claims represent an alternative source of data by which frailty might be more easily assessed. In the first paper, we, therefore, focused on ICD-9 claims-based frailty index and aimed to show the role of frailty on long-term mortality in patients undergoing transcatheter valve therapies. However, we realized that based on ICD-9 based claims may not comprehensively quantify frailty across all patients due to limited available number of codes. Since the transition to ICD-10 on October 1, 2015, which contains nearly 5-fold (from 14,000 to 70,000) the number of available claims, the increased granularity of claims data now permits a more comprehensive assessment of conditions associated with frailty and allows a more detailed longitudinal record of how frailty influences risk. Thus, in the second paper, we used an ICD-10 based frailty index to evaluate frailty and measure the impact of frailty on more outcomes (not only mortality) such as long hospital stay and readmission in patients undergoing transcatheter valve therapies.
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