Influence of age, frailty and non-cardiac comorbidities on survival in patients undergoing mitral valve edge-to-edge repair – a perspective from the German health care system

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Background and aims The influence of age, frailty, and non-cardiac comorbidities on long-term survival in a large, real-world cohort of patients undergoing mitral valve edge-to-edge-repair (M-TEER) was investigated. In addition, associated healthcare resource utilization and expenditure were evaluated. Methods Demographic data, data on frailty and co-morbidities were drawn from the anonymized database of the second largest sickness fund in Germany and analysed in regards of long-term survival. Results Relevant data was available in 4896 patients. Very old patients (80–99 years) had an impaired survival as compared to younger ones (OR 1.2, 95% CI [1.07;1.49], p = 0.005). With increasing level of frailty (care level 1: OR 1.43, 95% CI [1.19;1.72], p = 0.0001; care level 2: OR 1.63, 95% CI [1.45;1.84], p < 0.0001; care level 3–5: OR 2.09, 95% CI [1.79;2.45], p < 0.0001), and increasing number of non-cardiac comorbidities (one: OR 1.55, 95% CI [1.32, 1.82], p < 0.001; two: OR 2.21, 95% CI [1.90;2.59], p < 0.001, three or more: OR 2.82, 95% CI [2.37;3.36], p < 0.001) survival was significantly impaired. Female sex seems to be protective (OR 0.75, 95% CI [0.68;0.82], p < 0.001), whereas right heart failure at baseline (OR 1.83, 95% CI [1.65;2.03], p < 0.001) has a negative effect on survival. Overall medical expenses 12-months before the procedure were equal to 12-months after M-TEER (12-months before: 5796€ IQR [856.5;14,856.0] vs. 12-months after: 4.184€ IQR [370;15,316]. Conclusion Age, frailty and comorbidities play a significant role in survival prediction of patients undergoing M-TEER. Overall medical expanses did not change after M-TEER however heart failure hospitalizations were less frequent.

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