September 25, 2019Open Access

Association of Frailty With 30-Day Outcomes for Acute Myocardial Infarction, Heart Failure, and Pneumonia Among Elderly Adults

Structured PICO

Does the addition of the Hospital Frailty Risk Score (HFRS) to traditional comorbidity-based risk-adjustment models improve the prediction of 30-day mortality and readmission in elderly patients hospitalized for AMI, HF, or pneumonia?

Population

785,127 Medicare fee-for-service beneficiaries 65 years and older in the United States hospitalized for acute myocardial infarction (n=166,200 [21.2%]), heart failure (n=348,619 [44.4%]), or pneumonia (n=270,308 [34.4%]). Mean age 79.2 years, 51.3% women, 83.6% white.

Intervention

High frailty (Hospital Frailty Risk Score [HFRS] > 15) and the addition of HFRS to traditional comorbidity-based risk-adjustment models

Comparator

Low frailty (Hospital Frailty Risk Score < 5) and traditional comorbidity-based risk-adjustment models alone

Outcome

Rates of mortality within 30 days of admission and 30 days of discharge, as well as 30-day readmission rateshard clinical

The addition of a claims-based frailty metric (HFRS) to traditional comorbidity models significantly improves the prediction of 30-day mortality and readmission in elderly patients hospitalized for AMI, HF, and pneumonia.

Abstract

Importance: The addition of a claims-based frailty metric to traditional comorbidity-based risk-adjustment models for acute myocardial infarction (AMI), heart failure (HF), and pneumonia improves the prediction of 30-day mortality and readmission. This may have important implications for hospitals that tend to care for frail populations and participate in Centers for Medicare 656 315 (83.6%) were white and 402 639 (51.3%) were women. The mean (SD) HFRS was 7.3 (7.4) for patients with AMI, 10.8 (8.3) for patients with HF, and 8.2 (5.7) for patients with pneumonia. Among patients hospitalized for AMI, an HFRS more than 15 (compared with an HFRS <5) was associated with a higher risk of 30-day postadmission mortality (adjusted odds ratio aOR, 3.6; 95% CI, 3.4-3.8), 30-day postdischarge mortality (aOR, 4.0; 95% CI, 3.7-4.3), and 30-day readmission (aOR, 3.0; 95% CI, 2.9-3.1) after multivariable adjustment for age, sex, race, and comorbidities. Similar patterns were observed for patients hospitalized with HF (30-day postadmission mortality: aOR, 3.5; 95% CI, 3.4-3.7; 30-day postdischarge mortality: aOR, 3.5; 95% CI, 3.3-3.6; and 30-day readmission: aOR, 2.9; 95% CI, 2.8-3.0) and among patients with pneumonia (30-day postadmission mortality: aOR, 2.5; 95% CI, 2.3-2.6; 30-day postdischarge mortality: aOR, 3.0; 95% CI, 2.9-3.2; and 30-day readmission: aOR, 2.8; 95% CI, 2.7-2.9). The addition of HFRS to traditional comorbidity-based risk-prediction models improved discrimination to predict outcomes for all 3 conditions. Conclusions and Relevance: Among Medicare fee-for-service beneficiaries, frailty as measured by the HFRS was associated with mortality and readmissions among patients hospitalized for AMI, HF, or pneumonia. The addition of HFRS to traditional comorbidity-based risk-prediction models improved the prediction of outcomes for all 3 conditions.

Ask AI

Helpful

Bookmark

View Full Paper