HF in frailty confers worse mortality, longer hospital stays, more costly care
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Among patients with HF, those with frailty were more likely to have longer hospital stays, to die in-hospital and to incur larger medical costs than nonfrail patients, researchers reported.
“Clinical leaders should consider screening for frailty to identify a high-risk population that could potentially benefit from targeted intervention,” Sukruth A. Shashikumar, AB, student in cardiovascular division of the department of medicine at Washington University School of Medicine, St. Louis, and colleagues wrote. “Policymakers should consider incorporating frailty into risk adjustment when assessing hospital performance under ... value-based payment models. Doing so could yield more equitable quality measurement and subsequent allocation of financial bonuses and penalties.”
For the claims-based study published in JACC: Heart Failure, researchers assigned frailty scores to 732,932 adults (49% women; 67% white; 75% Medicare beneficiaries) in the National Inpatient Sample cohort with a primary diagnosis of HF from 2012 to September 2015. Patients were divided into two groups based on the presence of frailty to determine the relationship between frailty and outcomes in HF.
Researchers observed that frail patients with HF were more likely to die during a hospital stay (adjusted OR = 1.67; 95% CI, 1.61-1.72) compared with nonfrail patients.
Moreover, frail patients were less likely to be discharged to home (aOR = 0.58; 95% CI, 0.57-0.58) and incurred greater medical costs (adjusted difference = $9,006; 95% CI, 8,596-9,416; P < .001) compared with their nonfrail counterparts.
“The major finding was that frailty was highly predictive of poor clinical outcomes in patients hospitalized with HF,” Karen Joynt Maddox, MD, MPH, assistant professor of medicine and co-director of the Center for Health Economics and Policy in the Institute for Public Health at Washington University, St. Louis, Missouri, told Healio. “A simple claims-based or EMR-based frailty index that didn’t require any additional testing could identify patients who might benefit from targeted interventions or support.
“We were not surprised. Prior studies have shown that frailty is associated with poor clinical outcomes overall, but most prior studies have used in-person assessments of gait speed, grip strength, etc, which can be difficult to assess when someone is hospitalized and ill, and are impossible to collect on hundreds of thousands of patients nationally. To our knowledge, our study was the first to show that using an electronic frailty index in hospitalized HF patients could identify an at-risk group.”
Compared with nonfrail patients, those who were identified as frail were also more likely to be women (52.9% vs. 45%), white adults (70.1% vs. 64%) and be enrolled in Medicare (80.4% vs. 69.3%).
“Translating these findings to clinical interventions will require further investigation but represents an important next step in research,” the researchers wrote. “Additionally, translating these findings to policymaking will require further study as well. The effect of adjusting for patient frailty on health system performance, financial penalties and awards under value-based care models, and hospital public reporting has yet to be investigated.”
For more information:
Karen Joynt Maddox, MD, MPH, can be reached at kjoyntmaddox@wustl.edu.
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