Sharma Yogesh, Horwood Chris, Hakendorf Paul, Shahi Rashmi, Thompson Campbell
College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
Department of General Medicine, Division of Medicine, Cardiac and Critical Care, Flinders Medical Centre, Adelaide 5042, Australia.
J Clin Med. 2022 Apr 14;11(8):2193. doi: 10.3390/jcm11082193.
Frailty is common in older hospitalised heart-failure (HF) patients but is not routinely assessed. The hospital frailty-risk score (HFRS) can be generated from administrative data, but it needs validation in Australian health-care settings. This study determined the HFRS scores at presentation to hospital in 5735 HF patients ≥ 75 years old, admitted over a period of 7 years, at two tertiary hospitals in Australia. Patients were classified into 3 frailty categories: HFRS < 5 (low risk), 5−15 (intermediate risk) and >15 (high risk). Multilevel multivariable regression analysis determined whether the HFRS predicts the following clinical outcomes: 30-day mortality, length of hospital stay (LOS) > 7 days, and 30-day readmissions; this was determined after adjustment for age, sex, Charlson index and socioeconomic status. The mean (SD) age was 76.1 (14.0) years, and 51.9% were female. When compared to the low-risk HFRS group, patients in the high-risk HFRS group had an increased risk of 30-day mortality and prolonged LOS (adjusted OR (aOR) 2.09; 95% CI 1.21−3.60) for 30-day mortality, and an aOR of 1.56 (95% CI 1.01−2.43) for prolonged LOS (c-statistics 0.730 and 0.682, respectively). Similarly, the 30-day readmission rate was significantly higher in the high-risk HFRS group when compared to the low-risk group (aOR 1.69; 95% CI 1.06−2.69; c-statistic = 0.643). The HFRS, derived at admission, can be used to predict ensuing clinical outcomes among older hospitalised HF patients.
衰弱在老年住院心力衰竭（HF）患者中很常见，但未进行常规评估。医院衰弱风险评分（HFRS）可从管理数据中得出，但需要在澳大利亚的医疗环境中进行验证。本研究确定了澳大利亚两家三级医院在7年期间收治的5735名≥75岁HF患者入院时的HFRS评分。患者被分为3个衰弱类别：HFRS<5（低风险）、5 - 15（中度风险）和>15（高风险）。多水平多变量回归分析确定HFRS是否能预测以下临床结局：30天死亡率、住院时间（LOS）>7天和30天再入院率；这是在对年龄、性别、查尔森指数和社会经济状况进行调整后确定的。平均（标准差）年龄为76.1（14.0）岁，51.9%为女性。与低风险HFRS组相比，高风险HFRS组患者30天死亡率和住院时间延长的风险增加（30天死亡率的调整后比值比（aOR）为2.09；95%置信区间为1.21 - 3.60），住院时间延长的aOR为1.56（95%置信区间为1.01 - 2.43）（c统计量分别为0.730和0.682）。同样，与低风险组相比，高风险HFRS组的30天再入院率显著更高（aOR为1.69；95%置信区间为1.06 - 2.69；c统计量 = 0.643）。入院时得出的HFRS可用于预测老年住院HF患者随后的临床结局。
