Chun Shing Kwok1, Shelley Zieroth2, Harriette G C Van Spall3, Toby Helliwell4, Lorna Clarson4, Mohamed Mohamed5, Christian Mallen4, Simon Duckett6, Mamas A Mamas5. 1. Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK. Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK. Electronic address: shingkwok@doctors.org.uk. 2. St Boniface Hospital, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. 3. Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Canada. 4. Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK. 5. Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK. Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK. 6. Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Abstract
BACKGROUND: Little is known about frailty amongst patients hospitalized with heart failure (HF) on a national level. METHODS: We conducted a retrospective cohort study of patients admitted to hospital for HF in the United States. We examined how low, intermediate and high risk of frailty as defined by the Hospital Frailty Risk Score has changed over time and how it is related to inpatient mortality, length of stay, cost and discharge location. RESULTS: We included 11,626,400 inpatient episodes for HF. The proportions of patients that had low risk, intermediate and high risk of frailty were 80.0% (n = 9,300,873), 19.9% (n = 2,314,001) and 0.1% (n = 11,526). Intermediate or high risk of frailty increased from 9.9% in 2004 to 31.7% in 2014. Length of stay in hospital was greater in the high compared to low risk groups (11.3 days vs 4.6 days, respectively). The cost of admission was also greater in the high risk group ($23,084 ± 39,681) compared to the low risk group ($9103 ± 12,768). Intermediate and high risk of frailty groups were associated with increased in odds of mortality (OR 2.38 95% CI 2.22-2.34, p < 0.001 and OR 3.05 95%CI 2.57-3.62, p < 0.001, respectively) and discharge to nursing facilities (intermediate risk OR 1.52 95%CI 1.50-1.54, p < 0.001 and high risk OR 1.60 95%CI 1.35-1.90, p < 0.001). CONCLUSIONS: Frailty is significant and increasing in a national cohort of patients with HF in the United States. Patients at higher risk of frailty have increased in-hospital mortality, length of stay and inpatient costs, and a greater proportion are discharged to nursing home.
BACKGROUND: Little is known about frailty amongst patients hospitalized with heart failure (HF) on a national level. METHODS: We conducted a retrospective cohort study of patients admitted to hospital for HF in the United States. We examined how low, intermediate and high risk of frailty as defined by the Hospital Frailty Risk Score has changed over time and how it is related to inpatient mortality, length of stay, cost and discharge location. RESULTS: We included 11,626,400 inpatient episodes for HF. The proportions of patients that had low risk, intermediate and high risk of frailty were 80.0% (n = 9,300,873), 19.9% (n = 2,314,001) and 0.1% (n = 11,526). Intermediate or high risk of frailty increased from 9.9% in 2004 to 31.7% in 2014. Length of stay in hospital was greater in the high compared to low risk groups (11.3 days vs 4.6 days, respectively). The cost of admission was also greater in the high risk group ($23,084 ± 39,681) compared to the low risk group ($9103 ± 12,768). Intermediate and high risk of frailty groups were associated with increased in odds of mortality (OR 2.38 95% CI 2.22-2.34, p < 0.001 and OR 3.05 95%CI 2.57-3.62, p < 0.001, respectively) and discharge to nursing facilities (intermediate risk OR 1.52 95%CI 1.50-1.54, p < 0.001 and high risk OR 1.60 95%CI 1.35-1.90, p < 0.001). CONCLUSIONS: Frailty is significant and increasing in a national cohort of patients with HF in the United States. Patients at higher risk of frailty have increased in-hospital mortality, length of stay and inpatient costs, and a greater proportion are discharged to nursing home.
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