Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Abstract

Background Frailty is common among acute hospital patients and might adversely affect recovery from inpatient cardiac arrest. Aim To assess the relationship between hospital admission characteristics, including frailty, and discharge outcome after in‐hospital cardiac arrest. Methods Prospectively collected data were retrospectively analysed for all separations from a tertiary hospital during 2008–2017 that involved rapid response team attendance for cardiac arrest. Hospital Frailty Risk Score (HFRS) and Charlson index of comorbidity were calculated from ‘primary’ and ‘associated’ International Classification of Diseases, 10th revision, Australian Modification diagnoses. HFRS ≥5 was taken to signify frailty. Discharge home from hospital and death in hospital were modelled using logistic regression. Results There were 388 in‐hospital arrest patients: 91% were aged ≥50 years, 34% were previously discharged in the past 6 months, 66% were unplanned admissions, 63% were non‐cardiology‐cardiothoracic admissions, 45% had a Charlson comorbidity index ≥2 and 19% were identified as frail. Discharge home occurred in 22%, discharge to another hospital 17% and death 62%. Of the frail patients, only 3 (4%) were discharged home, 12 (17%) were discharged to another hospital and 57 (79%) died in hospital. Fewer frail patients were discharged home compared with non‐frail patients (4 vs 26%; odds ratio (OR) 0.13, P = 0.001). On multivariable analysis, patients were less likely to be discharged home if they had frailty (OR 0.24, P = 0.02), age ≥ 50 years (OR 0.36, P = 0.01), non‐cardiology‐cardiothoracic unit admission (OR 0.40, P = 0.001) and unplanned admission (OR 0.57, P = 0.04). Frail patients discharged to another hospital spent a median of 15 days (interquartile range 11–23) in the hospital post‐arrest before leaving to continue inpatient care elsewhere. Frailty was associated with death in hospital on univariate analysis (79 vs 58%; OR 2.80, P = 0.001) but not after controlling for other factors. Conclusion Frail patients are unlikely to make a good recovery after in‐hospital arrest. This should be taken into account when planning care with patients and their families.

Frailty, multimorbidity and in-hospital cardiopulmonary resuscitation: predictable markers of outcome?

“…Worldwide, Smith et al's Australian retrospective 10-year analysis first demonstrated a decreased likelihood of discharge from hospital for the frailest patients, but could not demonstrate an independent association with worsened survival. 16 This publication used the Hospital Frailty Risk Score (HFRS) to calculate patient frailty. The retrospective reviews of Ibitoye et al 14 and Wharton et al 13 are two other publications assessing the relationship between frailty and CPR outcome that have been published since we began collecting our data.…”

Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis

“…Increasing age and comorbidity burden are related to frailty, which describes a state of physiological decline and vulnerability 87. Future research should aim to investigate the association between frailty and outcomes after in-hospital cardiac arrest to help clinicians make a more accurate prognosis for patients admitted to hospital 88…”

Intensive care–treated cardiac arrest: A retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs

“…It is worth noting that age does not always correlate with outcome and is not in itself an adequate prognostic factor, as two elderly persons of the same age can have very different medical conditions [29]. High frailty and a low performance status have been connected with higher ECPSFNO and mortality in previous studies [30][31][32][33]. The increased mortality related to age in this study is indeed partially explained by the pre-admission functional status of the elderly patients; thus, this in combination with age seems to better predict both mortality and neurological outcome.…”