The Hospital Frailty Risk Score and its association with in-hospital mortality, cost, length of stay and discharge location in patients with heart failure short running title: Frailty and outcomes in heart failure

Kwok, Chun Shing; Zieroth, Shelley; Spall, Harriette G.C. Van; Helliwell, Toby; Clarson, Lorna; Mohamed, Mohamed; Mallen, Christian; Duckett, Simon; Mamas, Mamas A.

doi:10.1016/j.ijcard.2019.09.064

Cited by 61 publications

(69 citation statements)

References 17 publications

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“…Two recent studies using the same FI (the Hospital Frailty Risk Score) in patients hospitalized with HF have shown that frailty is also associated with higher rates of short and long-term mortality after discharge; a third confirmed the distinction between frailty and comorbidity by demonstrating a poor correlation between the Hospital Frailty Risk Score and the Charlson Comorbidity Index. [42][43][44] Frailty may also reduce a patient's ability to self-care and impair adherence because of associated cognitive impairment. [36][37][38] Polypharmacy increased with increasing frailty, not only causing concerns about adherence but also about drug-related adverse effects and interactions.…”

Section: Recurrent Non-cv Hospitalizationsmentioning

confidence: 99%

The prevalence and importance of frailty in heart failure with reduced ejection fraction – an analysis of PARADIGM‐HF and ATMOSPHERE

Dewan

Jackson

Jhund

et al. 2020

European J of Heart Fail

102

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Aims Frailty, characterized by loss of homeostatic reserves and increased vulnerability to physiological decompensation, results from an aggregation of insults across multiple organ systems. Frailty can be quantified by counting the number of ‘health deficits’ across a range of domains. We assessed the frequency of, and outcomes related to, frailty in patients with heart failure and reduced ejection fraction (HFrEF). Methods and results Using a cumulative deficits approach, we constructed a 42‐item frailty index (FI) and applied it to identify frail patients enrolled in two HFrEF trials (PARADIGM‐HF and ATMOSPHERE). In keeping with previous studies, patients with FI ≤0.210 were classified as non‐frail and those with higher scores were divided into two categories using score increments of 0.100. Clinical outcomes were examined, adjusting for prognostic variables. Among 13 625 participants, mean (± standard deviation) FI was 0.250 (0.10) and 8383 patients (63%) were frail (FI >0.210). The frailest patients were older and had more symptoms and signs of heart failure. Women were frailer than men. All outcomes were worse in the frailest, with high rates of all‐cause death or all‐cause hospitalization: 40.7 (39.1–42.4) vs. 22.1 (21.2–23.0) per 100 person‐years in the non‐frail; adjusted hazard ratio 1.63 (1.53–1.75) (P < 0.001). The rate of all‐cause hospitalizations, taking account of recurrences, was 61.5 (59.8–63.1) vs. 31.2 (30.3–32.2) per 100 person‐years (incidence rate ratio 1.76; 1.62–1.90; P < 0.001). Conclusion Frailty is highly prevalent in HFrEF and associated with greater deterioration in quality of life and higher risk of hospitalization and death. Strategies to prevent and treat frailty are needed in HFrEF.

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Section: Recurrent Non-cv Hospitalizationsmentioning

confidence: 99%

The prevalence and importance of frailty in heart failure with reduced ejection fraction – an analysis of PARADIGM‐HF and ATMOSPHERE

Dewan

Jackson

Jhund

et al. 2020

European J of Heart Fail

102

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“…The HFRS is a recently developed and validated score to measure frailty [4]. Moreover, individuals were categorized as low (<5), intermediate (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) or high risk (>15) for frailty based on previously published cut-off points [4]. Patients in the intermediate-risk and high-risk categories were defined as frail.…”

Section: Data Sourcesmentioning

confidence: 99%

Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes

Schnieder

Bähr

Kirsch

et al. 2021

JCM

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Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate whether frail patients also face adverse outcomes after experiencing an endovascular treated large vessel occlusion stroke (LVOS). In this retrospective observational cohort study, we analyzed patients ≥ 65 years that were admitted during 2015–2019 with LVOS and endovascular treatment. Primary outcomes were mortality and the modified Rankin Scale (mRS) after three months. Regression models were used to determine the impact of frailty. A total of 318 patients were included in the cohort. The median HFRS was 1.6 (IQR 4.8). A total of 238 (75.1%) patients fulfilled the criteria for a low-frailty risk with a HFRS < 5.72 (22.7%) for moderate-frailty risk with an HFRS from 5–15 and 7 (2.2%) patients for a high-frailty risk. Multivariate regression analyses revealed that the HFRS was associated with an increased mortality after 90 days (CI (95%) 1.001 to 1.236; OR 1.112) and a worse mRS (CI (95%) 1.004 to 1.270; OR 1.129). We identified frailty as an impact factor on functional outcome and mortality in patients undergoing thrombectomy in LVOS.

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“…Medical safety indicators can use "low risk group mortality" to reflect the probability of death of non-fatal disease cases [18]. From 2015 to 2020, the mortality rate of low-risk group in pilot hospitals showed a decreasing trend, with an average annual reduction rate of 21.21%, and that of control hospitals was 9.71%, as shown in Table 7.…”

Section: Mortality In Low Risk Groupmentioning

confidence: 99%

Analysis of the Effect of DRG Medical Insurance Payment on the Performance of Hospital Service in Hunan Province

Wang

Peng

et al. 2021

Preprint

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Background: Performance evaluation is an important means to promote the hospital's medical ability and management ability. Therefore, the aim of this study was to explore the effect of DRG payment mode on the performance of inpatient services in large tertiary hospitals. Methods: Based on the relevant report data of DRG pilot hospital and control hospital from 2015 to 2020, CN-DRG was used as grouping method, and case mix index (CMI), DRG group number, cost consumption index, time consumption index, low-risk group mortality and other indicators were used to analyze the impact of DRG on hospital inpatient service performance from the aspects of medical service ability, medical service efficiency, medical safety. Results: The average annual growth rate of DRG group was 4.07%, the average annual growth rate of CMI was 0.95%, the time consumption index and cost consumption index were lower than 1, and the mortality rate of low-risk group decreased by 27.56%. Conclusions: DRG medical insurance payment can improve the performance of inpatient service in the process of hospital management.

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The Hospital Frailty Risk Score and its association with in-hospital mortality, cost, length of stay and discharge location in patients with heart failure short running title: Frailty and outcomes in heart failure

Cited by 61 publications

References 17 publications

The prevalence and importance of frailty in heart failure with reduced ejection fraction – an analysis of PARADIGM‐HF and ATMOSPHERE

The prevalence and importance of frailty in heart failure with reduced ejection fraction – an analysis of PARADIGM‐HF and ATMOSPHERE

Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes

Analysis of the Effect of DRG Medical Insurance Payment on the Performance of Hospital Service in Hunan Province

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