Utility of the Hospital Frailty Risk Score Derived From Administrative Data and the Association With Stroke Outcomes

Abstract

Background and Purpose: Conditions associated with frailty are common in people experiencing stroke and may explain differences in outcomes. We assessed associations between a published, generic frailty risk score, derived from administrative data, and patient outcomes following stroke/transient ischemic attack; and its accuracy for stroke in predicting mortality compared with other measures of clinical status using coded data. Methods: Patient-level data from the Australian Stroke Clinical Registry (2009–2013) were linked with hospital admissions data. We used International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes with a 5-year look-back period to calculate the Hospital Frailty Risk Score (termed Frailty Score hereafter) and summarized results into 4 groups: no-risk (0), low-risk (1–5), intermediate-risk (5–15), and high-risk (>15). Multilevel models, accounting for hospital clustering, were used to assess associations between the Frailty Score and outcomes, including mortality (Cox regression) and readmissions up to 90 days, prolonged acute length of stay (>20 days; logistic regression), and health-related quality of life at 90 to 180 days (quantile regression). The performance of the Frailty Score was then compared with the Charlson and Elixhauser Indices using multiple tests (eg, C statistics) for predicting 30-day mortality. Models were adjusted for covariates including sociodemographics and stroke-related factors. Results: Among 15 468 adult patients, 15% died ≤90 days. The frailty scores were 9% no risk; 23% low, 45% intermediate, and 22% high. A 1-point increase in frailty (continuous variable) was associated with greater length of stay (OR adjusted , 1.05 [95% CI, 1.04 to 1.06), 90-day mortality (HR adjusted , 1.04 [95% CI, 1.03 to 1.05]), readmissions (OR adjusted , 1.02 [95% CI, 1.02 to 1.03]; and worse health-related quality of life (median difference, −0.010 [95% CI −0.012 to −0.010]). Adjusting for the Frailty Score provided a slightly better explanation of 30-day mortality (eg, larger C statistics) compared with other indices. Conclusions: Greater frailty was associated with worse outcomes following stroke/transient ischemic attack. The Frailty Score provides equivalent precision compared with the Charlson and Elixhauser indices for assessing risk-adjusted outcomes following stroke/transient ischemic attack.

Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis

“…Seven studies had at least one domain graded as high risk. All of these studies had problems with patient selection due to unnecessary exclusions [ 17 ]; a focus on intracerebral haemorrhage patients only [ 15 , 20 , 28 ] and recruitment limited to those offered mechanical thrombectomy [ 12 , 18 , 19 ]. In three studies [ 11 , 18 , 19 ] the method used to assess for pre-stroke frailty may have included post stroke complications.…”

“…All of these studies had problems with patient selection due to unnecessary exclusions [ 17 ]; a focus on intracerebral haemorrhage patients only [ 15 , 20 , 28 ] and recruitment limited to those offered mechanical thrombectomy [ 12 , 18 , 19 ]. In three studies [ 11 , 18 , 19 ] the method used to assess for pre-stroke frailty may have included post stroke complications. In three studies [ 11 , 16 , 19 ], there may not have been sufficient time for outcomes to develop, these were generally studies that assessed in-hospital outcomes only.…”

Higher Hospital Frailty Risk Score is associated with increased complications and healthcare resource utilization after endovascular treatment of ruptured intracranial aneurysms

“…Frailty was defined using the HFRS, a validated ICD-10 coding algorithm developed by Gilbert et al 17 and used in multiple studies. [19][20][21][22][23][24][25] The coding algorithm is derived from a cluster of frail individuals with 109 over-represented ICD-10 codes assigned a number of points ranging from 0.1 to 7.1 reflecting the strength of association to the frail cluster. 17 These points are added together for a final frailty risk score.…”

“…An increasing number of studies have shown the utility of the HFRS to predict mortality and poor health outcomes across a range of medical conditions and surgical procedures including pneumonia, acute myocardial infarction, COVID-19 hospitalizations, and revision total hip and knee arthroplasty 15 19–22. Other recent studies have explored the HFRS as a predictive tool in stroke 23. To date, the HFRS has not been explored in aneurysmal SAH.…”

“…15 19-22 Other recent studies have explored the HFRS as a predictive tool in stroke. 23 To date, the HFRS has not been explored in aneurysmal SAH.…”