Estenosis aórtica grave asintomática en la población geriátrica: papel de la fragilidad y la comorbilidad en la mortalidad / Asymptomatic aortic stenosis in a geriatric population. The role of frailty and comorbidity in mortality

Introducción y objetivos El pronóstico de la estenosis aórtica (EAo) grave asintomática en la población anciana, que a menudo asocia fragilidad y comorbilidades no ha sido estudiado. Se propuso analizar qué factores podrían influir en la mortalidad precoz esta población. Métodos Estudio ambispectivo de cohortes en 104 pacientes con edad ≥ 70 años y EAo grave asintomática. Se recogieron variables epidemiológicas, geriátricas, clínicas y ecocardiográficas y se compararon entre pacientes frágiles y no frágiles. Durante el seguimiento se recogió el tiempo desde el diagnóstico hasta la mortalidad. Resultados El 59,6% de los pacientes eran frágiles. El 69,4% de los pacientes frágiles fallecieron, con una mediana de supervivencia de 2,52 años (IC95%, 1,36-3,69). La tasa de supervivencia global al año en estos sujetos fue del 76%. En el análisis multivariante la edad (HR=2,47; IC95%, 1,00-6,12), el índice de Charlson ≥ 5 (HR=3,75; IC95%, 1,47-9,52) y la fragilidad (HR=6,67; IC95%, 1,43-9,52) se asociaron independientemente a la mortalidad. Un 8,7% de los pacientes presentaron un índice de Charlson ≥ 5 y tuvieron una mediana de supervivencia de 1,01 años (IC95%, 0,36-1,67). El área bajo la curva receiver operating characteristic del índice de Charlson fue 0,739 (IC95%, 0,646-0,832). Los valores ≥ 5 mostraron una elevada especificidad (100%) pero baja sensibilidad. Conclusiones Existe una elevada prevalencia de fragilidad en pacientes ancianos con EAo grave asintomáticos. La edad, un índice de Charlson ≥ 5 y la fragilidad son marcadores independientes de mortalidad, asociando un pronóstico desfavorable a corto plazo. (AU)

Introduction and objectives The prognosis of asymptomatic severe aortic stenosis (AS) has not been widely documented in elderly patients who are frequently frail and have comorbidities. We sought to analyze the factors that influence early mortality in geriatric patients with asymptomatic severe AS. Methods This ambispective cohort study included 104 patients aged 70 years or older with asymptomatic severe AS. Epidemiological, geriatric, clinical and echocardiographic variables were collected and compared between frail and nonfrail patients. During follow-up, the time from diagnosis to mortality and the causes of death were recorded. Results Overall, 59.6% of the patients were frail. During follow-up, 69.4% of the frail patients died, with a median time to mortality of 2.52 years (95%CI, 1.36-3.69). The overall 1-year survival rate in frail patients was 76%. On multivariate analysis, age (HR, 2.47; 95%CI, 1.00-6.12), a Charlson comorbidity index ≥ 5 (HR, 3.75; 95%CI, 1.47-9.52) and frailty (HR, 6.67; 95%CI, 1.43-9.52) were independently related to mortality. In total, 8.7% of the patients had a Charlson comorbidity index ≥ 5, and all these patients died during follow-up, with a median survival of 1.01 years (95%CI, 0.36-1.67). The area under the receiver operating characteristic curve of the Charlson index was 0.739 (95%CI, 0.646-0.832). In this population, values ≥ 5 showed high specificity (100%) but low sensitivity. Conclusions A high prevalence of frailty was present in geriatric patients with asymptomatic severe AS. Age, a Charlson index ≥ 5 and frailty were independent factors for mortality, conferring an unfavorable short-term prognosis. (AU)

Asymptomatic aortic stenosis in a geriatric population. The role of frailty and comorbidity in mortality.

INTRODUCTION AND OBJECTIVES: The prognosis of asymptomatic severe aortic stenosis (AS) has not been widely documented in elderly patients who are frequently frail and have comorbidities. We sought to analyze the factors that influence early mortality in geriatric patients with asymptomatic severe AS. METHODS: This ambispective cohort study included 104 patients aged 70 years or older with asymptomatic severe AS. Epidemiological, geriatric, clinical and echocardiographic variables were collected and compared between frail and nonfrail patients. During follow-up, the time from diagnosis to mortality and the causes of death were recorded. RESULTS: Overall, 59.6% of the patients were frail. During follow-up, 69.4% of the frail patients died, with a median time to mortality of 2.52 years (95%CI, 1.36-3.69). The overall 1-year survival rate in frail patients was 76%. On multivariate analysis, age (HR, 2.47; 95%CI, 1.00-6.12), a Charlson comorbidity index ≥ 5 (HR, 3.75; 95%CI, 1.47-9.52) and frailty (HR, 6.67; 95%CI, 1.43-9.52) were independently related to mortality. In total, 8.7% of the patients had a Charlson comorbidity index ≥ 5, and all these patients died during follow-up, with a median survival of 1.01 years (95%CI, 0.36-1.67). The area under the receiver operating characteristic curve of the Charlson index was 0.739 (95%CI, 0.646-0.832). In this population, values ≥ 5 showed high specificity (100%) but low sensitivity. CONCLUSIONS: A high prevalence of frailty was present in geriatric patients with asymptomatic severe AS. Age, a Charlson index ≥ 5 and frailty were independent factors for mortality, conferring an unfavorable short-term prognosis.