Frailty associated with lower PCI utilization, more readmissions after STEMI
Among patients admitted for acute MI, intermediate- or high-risk frailty is associated with lower utilization of PCI, greater length of stays, greater total costs and higher 30-day readmissions, researchers reported.
“Compared with non‐frail counterparts, frailty is associated with extended hospital stays and increased hospitalization index costs, especially after PCI,” Joseph Heaton, MD, MBA, MBS, of the department of internal medicine at The Brooklyn Hospital Center, New York, and colleagues wrote in Catheterization and Cardiovascular Interventions. “However, the impact of frailty in health care utilization and outcomes may be underestimated, as frail patients are more likely to be excluded from clinical trials.”
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In a retrospective study, Heaton and colleagues analyzed data from 584,918 patients admitted with an acute STEMI, using data from the 2016-2019 Nationwide Readmission Database, representing about 60% of all-payer hospitalizations in the U.S. The mean age of patients was 63.58 years; 30.63% were women. Researchers categorized patients by frailty risk, using the hospital frailty risk score, and then assessed the cohort for 30‐day readmission risk after acute STEMI, PCI utilization and outcomes, as well as health care resource utilization.
Within the cohort, 78.2% were classified as having low-risk frailty, 20.67% were classified as having intermediate-risk frailty and 1.14% had high-risk frailty.
Across all index admissions, 7.74% were readmitted within 30 days, with the rate of readmission increasing with frailty status (P < .001). Compared with those with low-risk frailty, patients with intermediate-risk frailty were 1.37 times more likely to be readmitted within 30 days (95% CI, 1.32-1.43; P < .001) and those with high-risk frailty were 1.21 times more likely to be readmitted (95% CI, 1.06-1.4; P = .005).
PCI was performed in 86.4% of low‐risk, 66.03% of intermediate‐risk, and 58.9% of high‐risk patients (P < .001). Intermediate-risk patients were 55.02% less likely and high‐risk patients were 61.26% less likely to undergo PCI than low-risk patients (P for both < .001).
Mean length of stay for index admissions was 2.96 days, 7.83 days and 16.32 days for the low-, intermediate-, and high‐risk frailty groups, respectively. Patients classified as having intermediate-risk and high‐risk frailty had a longer length of stay, higher total cost and were more likely to be discharged to a skilled facility compared with low-risk frailty patients (P < .001).
“Among adult, all‐payer inpatient visits, frailty discerned by the Hospital Frailty Risk Score was associated with increased readmissions, increased health care resource utilization and lower PCI administration,” the researchers wrote. “Future studies are needed to assess the impact of post-discharge compliance on reducing risk and adverse outcomes. As population age continually increases, the burden of frailty will become a significant priority. Utilizing the hospital frailty score provides an improved prediction model for adverse outcomes, risk‐benefit assessments of interventions, and will allow for goal‐oriented care of patients experiencing acute ST‐elevated myocardial infarctions.”
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