PMID- 34913364
OWN - NLM
STAT- MEDLINE
DCOM- 20220322
LR  - 20220716
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 10
IP  - 24
DP  - 2021 Dec 21
TI  - Association of Frailty With Treatment Selection and Long-Term Outcomes Among 
      Patients With Chronic Limb-Threatening Ischemia.
PG  - e023138
LID - 10.1161/JAHA.121.023138 [doi]
LID - e023138
AB  - 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 greater risk of poor outcomes and 
      guide treatment selection, but few studies have explored its utility among the 
      CLTI population. We examine the association of a health record-based frailty 
      measure with treatment choice and long-term outcomes among patients hospitalized 
      with CLTI. Methods and Results We included patients aged >65 years hospitalized 
      with CLTI in the Medicare Provider Analysis and Review data set between October 
      1, 2009 and September 30, 2015. The primary exposure was frailty, defined by the 
      Claims-based Frailty Indicator. Baseline frailty status and revascularization 
      choice 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. Of 85 060 patients, 35 484 (42%) 
      were classified as frail. Frail patients had lower likelihood of 
      revascularization (adjusted odds ratio [OR], 0.78; 95% CI, 0.75‒0.82). Among 
      those revascularized, frailty was associated with lower likelihood of surgical 
      versus endovascular treatment (adjusted OR, 0.76; CI, 0.72‒0.81). Frail patients 
      experienced increased risk of amputation or death, regardless of 
      revascularization status (revascularized: adjusted hazard ratio [HR], 1.34; CI, 
      1.30‒1.38; non-revascularized: adjusted HR, 1.22; CI, 1.17‒1.27). Among those 
      revascularized, frailty was independently associated with amputation or death 
      irrespective of revascularization strategy (surgical: adjusted HR, 1.36; CI, 
      1.31‒1.42; endovascular: aHR, 1.29; CI, 1.243‒1.35). Conclusions Among patients 
      hospitalized with CLTI, frailty is an important independent predictor of 
      revascularization strategy and longitudinal adverse outcomes.
FAU - Butala, Neel M
AU  - Butala NM
AUID- ORCID: 0000-0001-6937-4041
AD  - Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for 
      Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.
AD  - Cardiology Division Department of Medicine Massachusetts General HospitalHarvard 
      Medical School Boston MA.
FAU - Raja, Aishwarya
AU  - Raja A
AUID- ORCID: 0000-0001-9060-0648
AD  - Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for 
      Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.
AD  - Columbia University Irving Medical Center New York City NY.
FAU - Xu, Jiaman
AU  - Xu J
AD  - Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for 
      Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.
FAU - Strom, Jordan B
AU  - Strom JB
AUID- ORCID: 0000-0002-6592-6141
AD  - Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for 
      Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.
FAU - Schermerhorn, Marc
AU  - Schermerhorn M
AUID- ORCID: 0000-0002-4278-964X
AD  - Division of Vascular and Endovascular Surgery Department of Surgery Beth Israel 
      Deaconess Medical Center Boston MA.
FAU - Beckman, Joshua A
AU  - Beckman JA
AUID- ORCID: 0000-0001-8332-8439
AD  - Division of Cardiovascular Medicine Department of Medicine Vanderbilt University 
      Medical Center Nashville TN.
FAU - Shishehbor, Mehdi H
AU  - Shishehbor MH
AUID- ORCID: 0000-0002-4888-2431
AD  - Harrington Heart and Vascular InstituteCase Western Reserve University School of 
      Medicine and University Hospitals Cleveland Medical Center Cleveland OH.
FAU - Shen, Changyu
AU  - Shen C
AD  - Biogen, Inc. Cambridge MA.
FAU - Yeh, Robert W
AU  - Yeh RW
AUID- ORCID: 0000-0002-0564-4468
AD  - Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for 
      Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.
FAU - Secemsky, Eric A
AU  - Secemsky EA
AUID- ORCID: 0000-0003-3861-3163
AD  - Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for 
      Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.
LA  - eng
GR  - K23 HL144907/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20211216
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
SB  - IM
MH  - Aged
MH  - *Chronic Limb-Threatening Ischemia/therapy
MH  - *Clinical Decision-Making
MH  - *Frailty/epidemiology
MH  - Humans
MH  - Medicare
MH  - Treatment Outcome
MH  - United States/epidemiology
PMC - PMC9075246
OTO - NOTNLM
OT  - chronic limb-threatening ischemia
OT  - frailty
OT  - outcomes
EDAT- 2021/12/17 06:00
MHDA- 2022/03/23 06:00
PMCR- 2021/12/21
CRDT- 2021/12/16 08:42
PHST- 2021/12/17 06:00 [pubmed]
PHST- 2022/03/23 06:00 [medline]
PHST- 2021/12/16 08:42 [entrez]
PHST- 2021/12/21 00:00 [pmc-release]
AID - JAH37008 [pii]
AID - 10.1161/JAHA.121.023138 [doi]
PST - ppublish
SO  - J Am Heart Assoc. 2021 Dec 21;10(24):e023138. doi: 10.1161/JAHA.121.023138. Epub 
      2021 Dec 16.