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Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement.
Circulation. 2017 May 23; 135(21):2013-2024.Circ

Abstract

BACKGROUND

The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients' frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.

METHODS

We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.

RESULTS

Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman's ρ=-0.077, P=0.007), albumin (ρ=-0.22, P<0.001), gait speed (ρ=-0.28, P<0.001), and grip strength (ρ=-0.26, P<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%, P<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10-1.49; P<0.001).

CONCLUSIONS

In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.

Authors+Show Affiliations

From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. masa-nori@nms.ac.jp yamamoto@heart-center.or.jp.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai Kousei Hospital, Japan (N.T.); Department of Cardiology, Shonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); and Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28302751

Citation

Shimura, Tetsuro, et al. "Impact of the Clinical Frailty Scale On Outcomes After Transcatheter Aortic Valve Replacement." Circulation, vol. 135, no. 21, 2017, pp. 2013-2024.
Shimura T, Yamamoto M, Kano S, et al. Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. Circulation. 2017;135(21):2013-2024.
Shimura, T., Yamamoto, M., Kano, S., Kagase, A., Kodama, A., Koyama, Y., Tsuchikane, E., Suzuki, T., Otsuka, T., Kohsaka, S., Tada, N., Yamanaka, F., Naganuma, T., Araki, M., Shirai, S., Watanabe, Y., & Hayashida, K. (2017). Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. Circulation, 135(21), 2013-2024. https://doi.org/10.1161/CIRCULATIONAHA.116.025630
Shimura T, et al. Impact of the Clinical Frailty Scale On Outcomes After Transcatheter Aortic Valve Replacement. Circulation. 2017 May 23;135(21):2013-2024. PubMed PMID: 28302751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. AU - Shimura,Tetsuro, AU - Yamamoto,Masanori, AU - Kano,Seiji, AU - Kagase,Ai, AU - Kodama,Atsuko, AU - Koyama,Yutaka, AU - Tsuchikane,Etsuo, AU - Suzuki,Takahiko, AU - Otsuka,Toshiaki, AU - Kohsaka,Shun, AU - Tada,Norio, AU - Yamanaka,Futoshi, AU - Naganuma,Toru, AU - Araki,Motoharu, AU - Shirai,Shinichi, AU - Watanabe,Yusuke, AU - Hayashida,Kentaro, AU - ,, Y1 - 2017/03/16/ PY - 2016/09/22/received PY - 2017/03/01/accepted PY - 2017/3/18/pubmed PY - 2017/8/15/medline PY - 2017/3/18/entrez KW - OCEAN KW - clinical frailty scale KW - frailty KW - transcatheter aortic valve replacement SP - 2013 EP - 2024 JF - Circulation JO - Circulation VL - 135 IS - 21 N2 - BACKGROUND: The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients' frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement. METHODS: We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups. RESULTS: Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman's ρ=-0.077, P=0.007), albumin (ρ=-0.22, P<0.001), gait speed (ρ=-0.28, P<0.001), and grip strength (ρ=-0.26, P<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%, P<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10-1.49; P<0.001). CONCLUSIONS: In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/28302751/Impact_of_the_Clinical_Frailty_Scale_on_Outcomes_After_Transcatheter_Aortic_Valve_Replacement_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.025630?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -