Clinical implications of frailty in hospitalized patients with pulmonary arterial hypertension

Objectives Frailty is associated with increased morbidity and mortality in chronic lung disease, but its prognosis has not been evaluated in pulmonary arterial hypertension (PAH). This study aimed to assess: (1) impact of frailty on hospital length of stay (LOS) and health-care utilization in PAH; (2) association of frailty with 1-year post-discharge outcomes. Methods Retrospective, single-centered cohort study of consecutive PAH patients admitted non-electively (January 2009-December 2018), predominantly for right heart failure (57%). Frailty was defined as ≥ 0.25 using a cumulative deficits frailty index. Disease characteristics, hospital factors, and mortality were compared using univariate analysis and multivariable regression, adjusting for age and sex. Results 44/96 (46%) PAH patients were frail. Frailty was associated with older age, greater comorbidities, and lower six-minute walk distance pre-admission ( p < 0.05). Frail patients had a longer hospital LOS (4 days 95% (0.4–6.3), p = 0.04) and were more likely to receive social work consultation (36% vs 13%, p = 0.01), independent of age and sex. There were no adjusted differences (frail vs non-frail) in hospital mortality (OR:1.01 95% (0.28–3.72) or 12-months mortality post-discharge (HR:1.26 95% (0.48–3.29). Conclusion Frailty was associated with greater hospital LOS and interdisciplinary support, but not 1-year mortality. Future studies should explore whether alternative frailty models may be more informative of longer-term PAH outcomes.