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

Abstract

IMPORTANCEThe 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 & Medicaid Services value-based payment programs, which use these risk-adjusted metrics to determine reimbursement.OBJECTIVE To determine whether the addition of frailty measures to traditional comorbidity-based risk-adjustment models improved prediction of outcomes for patients with AMI, HF, and pneumonia. DESIGN, SETTING, AND PARTICIPANTSA nationwide cohort study included Medicare fee-for-service beneficiaries 65 years and older in the United States between January 1 and December 1, 2016. Analysis began August 2018. MAIN OUTCOMES AND MEASURESRates of mortality within 30 days of admission and 30 days of discharge, as well as 30-day readmission rates by frailty group. We evaluated the incremental effect of adding the Hospital Frailty Risk Score (HFRS) to current comorbidity-based risk-adjustment models for 30-day outcomes across all conditions.RESULTS For 785 127 participants, there were 166 200 hospitalizations [21.2%] for AMI, 348 619 [44.4%] for HF, and 270 308 [34.4%] for pneumonia. The mean (SD) age at the time of hospitalization was 79.2 (8.9) years; 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.

<p>Clinical Characteristics and Predictors of Mortality in Patients with COVID-19 Infection Outside Intensive Care</p>

“…Previous studies have shown frailty, independent of age, to correlate with poorer outcomes for respiratory diseases such as pneumonia. 24,25 We demonstrated that increasing frailty score positively correlated with poorer outcomes in those with COVID-19. Further studies should aim to determine whether this link remains after accounting for age and other specific comorbidities.…”

The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

“…The largest study of frailty in critical illness showed that frail adults were twice as likely to die in the hospital and within 1 year than the non-frail [32,33]. Frailty is not only independently associated with hospitalizations and mortality in adults with pneumonia but also appears to have a synergistic effect on respiratory function along with lung disease [34,35] Previous studies have found that age, cardiovascular disease, and cerebrovascular disease were predictive of fatal outcomes [24]. In our study, comorbidities were not associated with higher risk of severe disease in either univariate or multivariate analyses including frailty.…”

Variation in Acute Care Rehabilitation and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia

“… 3 Pneumonia is also a common reason for hospital readmission, particularly among older adults, who often experience a functional decline during the index admission. 4 , 5 , 6 , 7 , 8 Studies have identified an inverse association between functional status and risk of hospital readmission. 9 , 10 , 11 , 12 In addition, there is a growing body of literature on the detrimental effects of acute care hospitalization on functional independence.…”