Association of frailty with treatment selection and long-term outcome in patients with chronic limb-threatening ischemia

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J Am Heart Assoc. December 16, 2021: e023138. doi: 10.1161 / JAHA.121.023138. Online ahead of print.


Background The optimal treatment strategy for patients with chronic limb threatening ischemia (CLTI) is often unclear. Frailty has emerged as an important factor that can identify patients at increased risk of poor outcome and guide treatment choice, but few studies have explored its utility in the CLTI population. We examine the association of a record-based measure of frailty with treatment choice and long-term outcome in patients hospitalized for CLTI. Methods and Results We included patients over 65 years of age hospitalized for CLTI in the Medicare Provider Analysis and Review dataset between October 1, 2009 and September 30, 2015. The primary exposure was frailty, defined by the Claims-based Frailty Indicator. Baseline frailty and choice of revascularization were examined using logistic regression. Cox proportional hazards regression was used to determine the association between frailty and death or amputation, stratifying by treatment strategy. Out of 85,060 patients, 35,484 (42%) were classified as frail. Frail patients had a lower likelihood of revascularization (adjusted odds ratio [OR], 0.78; 95% CI, 0.75‒0.82). Among revascularized individuals, frailty was associated with a lower likelihood of surgical treatment compared to endovascular treatment (adjusted OR: 0.76; CI: 0.72‒0.81). Frail patients were at increased risk of amputation or death, regardless of their revascularization status (revascularized: adjusted risk ratio [HR], 1.34; IC, 1.30‒1.38; non-revascularized: adjusted HR, 1.22; IC, 1.17‒1.27). Among revascularized individuals, frailty was independently associated with amputation or death, regardless of the revascularization strategy (surgical: adjusted RR, 1.36; CI, 1.31‒1.42; endovascular: HRa, 1 , 29; IC, 1.243‒1.35). Conclusions Among patients hospitalized with CLTI, frailty is an important independent predictor of revascularization strategy and longitudinal adverse outcomes.

PMID: 34913364 | DOI: 10.1161 / JAHA.121.023138

Martin E. Berry