Frailty and Survival After In-Hospital Cardiopulmonary Resuscitation

Hu, Frances Y.; Streiter, Shoshana; O'Mara, Lynne; Sison, Stephanie Denise; Theou, Olga; Bernacki, Rachelle; Orkaby, Ariela R.

doi:10.1007/s11606-021-07199-1

Cited by 21 publications

(23 citation statements)

References 41 publications

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“…We modified the frailty cut-off score in one study to include a CFS score of four in the non-frail group, consistent with other studies and standard clinical practices. 22 Percentage mortality in non-frail participants undergoing CPR was 71.6% compared to 90.2% in frail participants. One study found that no frail patients survived to discharge, 19 while another found only one frail patient survived.…”

Section: Resultsmentioning

confidence: 94%

“…Eight studies comparing the outcomes in frail versus non-frail individuals receiving CPR for cardiac arrest were included in a narrative synthesis ( Table 1 ). 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Of these, seven studies presented sufficient data for inclusion in quantitative synthesis. All studies included in meta-analysis were of a retrospective observational design and considered to be of high methodological quality ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…visitors, patients in emergency department) Tertiary referral hospital, Australia • Readmission to hospital within 30 days from discharge • Chest compressions and/or electrical defibrillation performed • Cardiac arrest in subacute units (e.g. palliative care, geriatric medicine) Ibitoye, 19 2020 Retrospective observational CFS (≥5) • Survival to discharge • IHCA in patients (>60) who received CPR • Repeat cardiac arrests Tertiary referral hospital, UK • Discharge location • Cases where CPR was discontinued due to presence of DNACPR • One year survival • CFS score non-determinable • Non-true cardiac arrest Xu, 20 2020 Retrospective observational CFS (≥5) • In-hospital mortality • Adult (≥18) IHCA • None Zigong fourth people’s hospital, China Sulzgruber, 21 2016 Prospective observational N/A • ROSC • OHCA with resuscitation attempt by emergency medical service • No professional resuscitation attempt Out-of-hospital, Austria • 30 day survival • DNACPR decision present • Favourable cerebral performance category Thomas, 23 2021 Retrospective observational CFS (≥5) • ROSC • Adult (>16) IHCA • DNACPR decision present Tertiary hospital, UK • 30 day survival • OHCA • Survival to discharge • One year survival Hu, 22 2021 ...…”

Section: Resultsmentioning

confidence: 99%

“…One study presented a moderate risk of bias (overall score 4–6). Study Selection Comparability of cohorts Outcome Overall score (/9) Exposed cohort Non-exposed cohort Exposure ascertainment Outcome not present at start Assessment of outcome Follow-up length Follow-up adequacy Wharton, 16 2019 * * * * ** * * * 9 Sulzgruber, 21 2016 * * * ** * 6 Fernando, 17 2019 * * * * *** * * * 9+ Smith, 18 2018 * * * * *** * * * 9+ Ibitoye, 19 2020 * * * * *** * * * 9+ Xu, 20 2020 * * * * *** * * * 9+ Thomas, 23 2021 * * * * * * * 7 Hu, 22 ...…”

Section: Resultsmentioning

confidence: 99%

“…All three studies demonstrated that greater severity of frailty was associated with reduced odds of survival. 20 , 22 , 23 …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Outcomes in adults living with frailty receiving cardiopulmonary resuscitation: A systematic review and meta-analysis

Hamlyn

Lowry²,

Jackson³

et al. 2022

Resuscitation Plus

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…All three studies demonstrated that greater severity of frailty was associated with reduced odds of survival. 20 , 22 , 23 …”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Outcomes in adults living with frailty receiving cardiopulmonary resuscitation: A systematic review and meta-analysis

Hamlyn

Lowry²,

Jackson³

et al. 2022

Resuscitation Plus

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Frailty and Outcomes Following Cardiopulmonary Resuscitation for Perioperative Cardiac Arrest

et al. 2023

Self Cite

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ImportanceFrailty is associated with mortality following surgery and cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest. Despite the growing focus on frailty as a basis for preoperative risk stratification and concern that CPR in patients with frailty may border on futility, the association between frailty and outcomes following perioperative CPR is unknown.ObjectiveTo determine the association between frailty and outcomes following perioperative CPR.Design, Setting, and ParticipantsThis longitudinal cohort study of patients used the American College of Surgeons National Surgical Quality Improvement Program, including more than 700 participating hospitals in the US, from January 1, 2015, through December 31, 2020. Follow-up duration was 30 days. Patients 50 years or older undergoing noncardiac surgery who received CPR on postoperative day 0 were included; patients were excluded if data required to determine frailty, establish outcome, or perform multivariable analyses were missing. Data were analyzed from September 1, 2022, through January 30, 2023.ExposuresFrailty defined as Risk Analysis Index (RAI) of 40 or greater vs less than 40.Outcomes and MeasuresThirty-day mortality and nonhome discharge.ResultsAmong the 3149 patients included in the analysis, the median age was 71 (IQR, 63-79) years, 1709 (55.9%) were men, and 2117 (69.2%) were White. Mean (SD) RAI was 37.73 (6.18), and 792 patients (25.9%) had an RAI of 40 or greater, of whom 534 (67.4%) died within 30 days of surgery. Multivariable logistic regression adjusting for race, American Society of Anesthesiologists physical status, sepsis, and emergency surgery demonstrated a positive association between frailty and mortality (adjusted odds ratio [AOR], 1.35 [95% CI, 1.11-1.65]; P = .003). Spline regression analysis demonstrated steadily increasing probability of mortality and nonhome discharge with increasing RAI above 37 and 36, respectively. Association between frailty and mortality following CPR varied by procedure urgency (AOR for nonemergent procedures, 1.55 [95% CI, 1.23-1.97]; AOR for emergent procedures, 0.97 [95% CI, 0.68-1.37]; P = .03 for interaction). An RAI of 40 or greater was associated with increased odds of nonhome discharge compared with an RAI of less than 40 (AOR, 1.85 [95% CI, 1.31-2.62]; P &lt; .001).Conclusions and RelevanceThe findings of this cohort study suggest that although roughly 1 in 3 patients with an RAI of 40 or greater survived at least 30 days following perioperative CPR, higher frailty burden was associated with increased mortality and greater risk of nonhome discharge among survivors. Identifying patients who are undergoing surgery and have frailty may inform primary prevention strategies, guide shared decision-making regarding perioperative CPR, and promote goal-concordant surgical care.

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Frailty as a predictor of mortality and readmission rate in secondary mitral regurgitation

Uzel

Rezar

Bruno

et al. 2023

Wien Klin Wochenschr

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Summary Introduction Selection in patients with functional mitral regurgitation (MR) to identify responders to interventions is challenging. In these patients, frailty might be used as a multidimensional parameter to summarize the resilience to stressors. Our objective was to evaluate frailty as a predictor of outcome in patients with moderate to severe secondary MR. Methods We conducted a single-center retrospective observational cohort study and included 239 patients with moderate to severe secondary MR aged 65 years or older between 2014 and 2020. Echocardiography was performed at baseline; frailty was evaluated using the clinical frailty scale (CFS). The combined primary endpoint was hospitalization for heart failure and all-cause mortality. Results A total of 53% (127) of all patients were classified as CFS 4 (living with mild frailty) or higher. Frail patients had a higher risk for the combined endpoint (hazard ratio, HR 3.70, 95% confidence interval, CI 2.12–6.47; p < 0.001), 1‑year mortality (HR 5.94, 95% CI 1.76–20.08; p < 0.001) even after adjustment for EuroSCORE2. The CFS was predictive for the combined endpoint (AUC 0.69, 95% CI 0.62–0.75) and outperformed EuroSCORE2 (AUC 0.54, 95% CI 0.46–0.62; p = 0.01). In sensitivity analyses, we found that frailty was associated with adverse outcomes at least in trend in all subgroups. Conclusion For older, medically treated patients with moderate to severe secondary mitral regurgitation, frailty is an independent predictor for the occurrence of death and heart failure-related readmission within 1 year and outperformed the EuroSCORE2. Frailty should be assessed routinely in patients with heart failure to guide clinical decision making for mitral valve interventions or conservative treatment.

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Frailty and Survival After In-Hospital Cardiopulmonary Resuscitation

Cited by 21 publications

References 41 publications

Outcomes in adults living with frailty receiving cardiopulmonary resuscitation: A systematic review and meta-analysis

Outcomes in adults living with frailty receiving cardiopulmonary resuscitation: A systematic review and meta-analysis

Frailty and Outcomes Following Cardiopulmonary Resuscitation for Perioperative Cardiac Arrest

Frailty as a predictor of mortality and readmission rate in secondary mitral regurgitation

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