Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV

Impact of frailty assessment on outcomes in critical acute myocardial infarction: Insights from the hospital frailty risk measure (HFRM)

BACKGROUND

Frailty impacts outcomes in critical Acute Myocardial Infarction (AMI). This study evaluates three Hospital Frailty Risk Measure (HFRM) formats-continuous score, 8 risk groups, and binary classification-for predicting clinical outcomes.

METHODS

Using 2129 critical AMI patients' data from MIMIC-IV, logistic and COX regression models assessed associations between HFRM formats and outcomes (ICU mortality, in-hospital mortality, discharge with nursing support, one-year mortality), adjusted for age, gender, smoking, and NSTEMI.

RESULTS

All HFRM formats consistently predicted adverse outcomes. The continuous score showed increased adjusted odds/hazard ratios for ICU mortality (OR 1.289, 95 % CI:1.065-1.516), in-hospital mortality (OR 1.343, 95 % CI:1.161-1.554), nursing support discharge (2.389, 95 % CI: 1.960-2.912), and one-year mortality (1.709, 95 % CI:1.533-1.904). The binary measure (groups 4-8 as frail) demonstrated higher adjusted risks for all outcomes except ICU mortality.

CONCLUSION

HFRM effectively predicts adverse outcomes in critical AMI. The binary classification offers robust risk stratification, underscoring frailty assessment's role in personalized care planning.

Revascularization in frail patients with acute coronary syndromes: a retrospective longitudinal study

BACKGROUND AND AIMS

Frailty is increasingly prevalent in people presenting with acute coronary syndrome (ACS). This high-risk group is typically excluded from trials of interventions in ACS, and there is uncertainty about the risks and benefits of invasive management.

METHODS

Patients with an ACS diagnosis between 2010 and 2015 in England were identified from Hospital Episode Statistics, with linked Office for National Statistics mortality data. Frailty was defined by the Hospital Frailty Risk Score. Causal inference analysis used regional variation in revascularization as an instrumental variable to estimate average treatment effects of revascularization on cardiovascular mortality up to 5 years in people presenting with ACS and low-, intermediate-, or high-risk frailty.

RESULTS

The analysis included 565 378 ACS patients, of whom 11.6% (n = 65 522) were at intermediate risk and 4.7% (n = 26 504) were at high risk of frailty. Intermediate and high frailty risks were associated with reduced likelihood of echocardiography, invasive angiography, or revascularization and increased likelihood of mortality and major adverse cardiovascular events compared with low frailty risk. Cardiovascular death at 5 years was 78.6%, 77.3%, and 75.7% in people at low, intermediate, and high frailty risk, respectively. Instrumental variable analysis suggested that revascularization resulted in a higher absolute reduction in cardiovascular mortality in high and intermediate frail risk patients compared with low risk at 1-year post-ACS.

CONCLUSIONS

Frailty is common in people presenting with ACS, where cardiovascular causes are the principal mode of death. Revascularization is associated with short- and long-term survival benefits in people at intermediate and high risk of frailty after adjustment for measured and unmeasured confounders.

The Association of Myocardial Infarction History and Geriatric Syndromes in the Elderly: Data from the Cross-Sectional Study EVKALIPT

Background/Objectives: In recent decades, the number of patients with chronic cardiovascular diseases (CVDs) has increased, and CVD survivors are more likely to be old and frail and to have multiple comorbidities. A better understanding of geriatric conditions and their prevalence would help improve the management of older patients with CVDs. The main objective of this study is to estimate the association of myocardial infarction (MI) history with geriatric syndromes (GSs) in people 65 years of age and older. Methods: The cross-sectional study EVKALIPT included patients who were 65 years of age and older. All patients underwent a comprehensive geriatric assessment. The presence of MI history was assessed by medical records. Results: A total of 4295 participants were included. The prevalence of MI history was 12.6%. According to univariate regression analysis, MI history was associated with an increase in the odds of 12 GSs by 1.3-2.4 times. Multivariate regression analysis showed that male sex and four GSs (impairment in basic and instrumental activities of daily living, depression, falls) were independently associated with a history of MI, with the odds ratio ranging from 1.28 to 1.86. Conclusions: This study showed the association between MI history and GSs.

Impact of Frailty and Delirium Among Older Adults Admitted With Acute Decompensated Heart Failure

Background

The presence of frailty or delirium among patients hospitalized for acute decompensated heart failure (ADHF) is associated with increased mortality and prolonged hospital stay.

Objectives

The purpose of this study was to assess the combined effect of frailty and delirium on in-hospital mortality and disposition at discharge among older adults hospitalized with ADHF.

Methods

We conducted a retrospective observational study using Nationwide Inpatient Sample data from the Agency for Healthcare Research and Quality from 2016 to 2018. Patients aged 65 years or older with a diagnosis of ADHF (both with preserved and reduced left ventricular ejection fraction) were included. For analysis, we conducted a multivariable logistic regression analysis to determine OR for in-hospital mortality or nonhome discharge from delirium and frailty.

Results

A total of 3,577,433 weighted number of hospitalizations with ADHF were included. Delirium, moderate frailty risk, and high frailty risk increased the OR for in-hospital mortality (3.74; 95% CI: 3.70-3.78, 4.02; 95% CI: 3.96-4.09, and 8.63; 95% CI: 8.47-8.78, respectively) and nonhome discharge (4.21; 95% CI: 4.18-4.25, 2.95; 95% CI: 2.94-2.97, and 8.86; 95% CI: 8.78-8.94, respectively). When the combination of delirium and frailty was assessed, compared to those without delirium and with low frailty risk, the OR of mortality among those with delirium and high frailty risk was the highest at 12.18 (95% CI: 11.89-12.48). For nonhome discharge, the OR was the highest among those with delirium and high frailty risk at 14.01 (95% CI: 13.77-14.26).

Conclusions

Frailty and delirium, independently and in combination, led to higher odds of in-hospital mortality and nonhome disposition at discharge among patients hospitalized with ADHF.

Association of frailty and sarcopenia with short-term mortality in older critically ill patients

BACKGROUND

There is still no study on the use of the SARC-CalF questionnaire for older critically ill patients. Moreover, there is limited evidence on whether a combination of sarcopenia and frailty can provide incremental improvements in risk stratification for older critically ill patients.

METHODS

A total of 653 patients older than 60 years were recruited. We used the clinical frailty scale (CFS) and SARC-CalF questionnaire to assess the frailty status and sarcopenia risk, respectively, of older patients shortly after admission to the ICU. The effect of frailty and sarcopenia risk on ICU mortality and 30-day mortality was evaluated.

RESULTS

A total of 147 (22.5%) patients died in the ICU, and 187 (28.6%) patients died within 30 days after ICU admission. The CFS score was associated with increased ICU mortality [per 1-score increase: odds ratio (OR) = 1.222, 95% confidential interval (CI): 1.003-1.489] and 30-day mortality (per 1-score increase: OR = 1.307, 95% CI: 1.079-1.583). The SARC-CalF score was also associated with increased ICU mortality (per 1-score increase: OR = 1.204, 95% CI: 1.120-1.294) and 30-day mortality (per 1-score increase: OR = 1.247, 95% CI: 1.163-1.337). The addition of the CFS + SARC-CalF score to Acute Physiology and Chronic Health Evaluation (APACHE) II improved discrimination and reclassified ICU and 30-day mortality risk.

CONCLUSIONS

Sarcopenia risk assessed by the SARC-CalF questionnaire provided independent prognostic information for older critically ill patients. A combination of sarcopenia and frailty improved the prediction of mortality for older critically ill patients and thus might be useful in the clinical decision-making process.

The association between frailty and in-hospital mortality in critically ill patients with congestive heart failure: results from MIMIC-IV database

Background

Frailty correlates with adverse outcomes in many cardiovascular diseases and is prevalent in individuals with heart failure (HF). The Hospital Frailty Risk Score (HFRS) offers an integrated, validated solution for frailty assessment in acute care settings, but its application in critically ill patients with congestive HF lacks exploration. This study aimed to identify the association between frailty assessed by the HFRS and in-hospital mortality in critically ill patients with congestive HF.

Methods

This observational study retrospectively enrolled 12,179 critically ill patients with congestive HF. Data from the Medical Information Mart for Intensive Care IV database was used. The HFRS was calculated to assess frailty. Patients were categorized into three groups: non-frailty (HFRS < 5, n = 7,961), pre-frailty (5 ≤ HFRS < 15, n = 3,684), and frailty (HFRS ≥ 15, n = 534). Outcomes included in-hospital mortality, length of intensive care unit stay, and length of hospital stay. Multiple logistic regression and Locally Weighted Scatterplot Smoothing (LOWESS) smoother were used to investigate the association between frailty and outcomes. Subgroup analysis was employed to elucidate the correlation between frailty levels and in-hospital mortality across diverse subgroups.

Results

12,179 patients were enrolled, 6,679 (54.8%) were male, and the average age was 71.05 ± 13.94 years. The overall in-hospital mortality was 11.7%. In-hospital mortality increased with the escalation of frailty levels (non-frailty vs. pre-frailty vs. frailty: 9.7% vs. 14.8% vs. 20.2%, P < 0.001). The LOWESS curve demonstrated that the HFRS was monotonically positively correlated with in-hospital mortality. Upon controlling for potential confounders, both pre-frailty and frailty statuses were found to be independently linked to a heightened risk of mortality during hospitalization (odds ratio [95% confidence interval]: pre-frailty vs. non-frailty: 1.27 [1.10-1.47], P = 0.001; frailty vs. non-frailty: 1.40 [1.07-1.83], P = 0.015; P for trend < 0.001). Significant interactions between frailty levels and in-hospital mortality were observed in the following subgroups: race, heart rate, creatinine, antiplatelet drug, diabetes, cerebrovascular disease, chronic renal disease, and sepsis.

Conclusion

In critically ill patients with congestive HF, frailty as assessed by the HFRS emerged as an independent predictor for the risk of in-hospital mortality. Prospective, randomized studies are required to determine whether improvement of frailty levels could improve clinical prognosis.

Association of Frailty with Adverse Outcomes in Patients with Critical Acute Myocardial Infarction: A Retrospective Cohort Study

Background

Frailty is a risk factor for acute myocardial infarction (AMI). This study examined the association between the modified frailty index (MFI) and adverse outcomes in patients with critical AMI.

Methods

Data were obtained from the Medical Information Mart for Intensive Care IV database. Logistic and Cox regression models and a competing risk model were applied.

Results

Of 5003 patients, 1496 were non-frail and 3507 were frail. Frailty was significantly associated with in-hospital mortality (per point, OR 1.13, 95% CI: 1.05-1.21; frail vs non-frail, OR 1.31, 95% CI: 1.04-1.65) and 1-year mortality (per point, HR 1.15, 95% CI: 1.11-1.20; frail vs non-frail, HR 1.37, 95% CI: 1.20-1.58). Frailty was significantly associated with post-discharge care needs (per point, OR 1.23, 95% CI: 1.14-1.33; frail vs non-frail, OR 1.47, 95% CI: 1.22-1.78). In the competing risk models, frailty was significantly associated with a lower probability of being discharged from the ICU (per point, HR 0.87, 95% CI: 0.85-0.90; frail vs non-frail, HR 0.73, 95% CI: 0.68-0.79) and hospital (per point, HR 0.82, 95% CI: 0.80-0.85; frail vs non-frail, HR 0.62, 95% CI: 0.57-0.68). Subgroup analyses showed the association of frailty with in-hospital and 1-year mortality was stronger in patients with a SOFA score ≤2 than in those with a SOFA score >2 (both p<0.05 for interaction).

Conclusion

Frailty assessed by the MFI was an independent predictor of adverse outcomes in patients with critical AMI and may be helpful for prognostic risk stratification.