衰弱与Impella机械循环支持后再入院及预后的关联
Association of Frailty With Readmissions and Outcomes After Impella Mechanical Circulatory Support.
作者信息
Maffey Max W, Kuchtaruk Adrian A, Damluji Abdulla A, García Santiago, Elgendy Islam Y, Villablanca Pedro, Moroni Francesco, Denicolai Martin, Mamas Mamas A, Bagur Rodrigo
机构信息
London Health Sciences Centre, Western University, London, Ontario, Canada.
Inova Center of Outcomes Research, Fairfax, Virginia, USA.
出版信息
CJC Open. 2025 Apr 22;7(7):972-985. doi: 10.1016/j.cjco.2025.04.011. eCollection 2025 Jul.
BACKGROUND
Frailty is associated with a greater risk of readmission after cardiovascular procedures. However, the impact of frailty on readmission rates and outcomes after Impella mechanical circulatory support (MCS) remains unknown. We aimed to explore the impact of frailty on readmission outcomes in patients who received Impella MCS.
METHODS
Using the National Readmissions Database, patients aged 65 years and older who received Impella MCS between January 2016 and December 2020 were identified. Frailty was determined by the Hospital Frailty Risk Score (HFRS), which stratifies patients into 3 frailty risk categories as low (<5), intermediate (5-15), and high (>15), with intermediate- and high-risk groups defined as frail. The impact of frailty on short-term (within 30 days) and midterm (31-180 days) readmission rates and in-hospital outcomes was assessed.
RESULTS
Of the 16,289 patients identified in the 30-day cohort, 8647 (53.1%) were identified as frail (HFRS ≥5) and 2185 (13.4%) had an unplanned readmission at 30 days. After adjusting for age, sex and comorbidities, frailty status (HFRS ≥5) was associated with a greater risk of 30-day readmission (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.17-1.37), death (OR 2.0, 95% CI 1.22-3.30), major adverse events (OR 1.73, 95% CI 1.29-2.33), length of stay >4 days (OR 1.80, 95% CI 1.44-2.26) and greater hospitalization expenditures (OR 1.44, 95% CI 1.17-1.80) during readmission. Of the 6497 patients identified in the 31-180-day cohort, 3521 (54.2%) were considered frail and 1809 (27.8%) experienced unplanned readmissions. An HFRS ≥5 was associated with a greater risk of readmission (OR 2.10, 95% CI 1.88-2.34), in-hospital death (OR 3.02, 95% CI 1.33-6.86), length of stay >4 days (OR 1.66, 95% CI 1.29-2.14), and greater hospital expenditures (OR 1.36, 95% CI 1.05-1.75) during 31-180-day readmission.
CONCLUSIONS
Frailty is common among patients undergoing Impella MCS and is associated with higher rates of readmission and adverse outcomes during readmission.
背景
衰弱与心血管手术后再入院风险增加有关。然而，衰弱对接受Impella机械循环支持（MCS）后的再入院率和结局的影响尚不清楚。我们旨在探讨衰弱对接受Impella MCS患者再入院结局的影响。
方法
利用国家再入院数据库，确定2016年1月至2020年12月期间接受Impella MCS的65岁及以上患者。通过医院衰弱风险评分（HFRS）确定衰弱情况，该评分将患者分为3个衰弱风险类别，即低风险（<5分）、中度风险（5 - 15分）和高风险（>15分），中度和高风险组被定义为衰弱。评估衰弱对短期（30天内）和中期（31 - 180天）再入院率及住院结局的影响。
结果
在30天队列中确定的16289例患者中，8647例（53.1%）被确定为衰弱（HFRS≥5），2185例（13.4%）在30天时有非计划再入院。在调整年龄、性别和合并症后，衰弱状态（HFRS≥5）与30天再入院风险增加（比值比[OR]1.27，95%置信区间[CI]1.17 - 1.37）、死亡（OR 2.0，95% CI 1.22 - 3.30）、主要不良事件（OR 1.73，95% CI 1.29 - 2.33）、住院时间>4天（OR 1.80，95% CI 1.44 - 2.26）以及再入院期间更高的住院费用（OR 1.44，95% CI 1.17 - 1.80）相关。在31 - 180天队列中确定的6497例患者中，3521例（54.2%）被认为衰弱，1809例（27.8%）经历了非计划再入院。HFRS≥5与31 - 180天再入院风险增加（OR 2.10，95% CI 1.88 - 2.34）、住院死亡（OR 3.02，95% CI 1.33 - 6.86）、住院时间>4天（OR 1.66，95% CI 1.29 - 2.14）以及更高的医院费用（OR 1.36，95% CI 1.05 - 1.75）相关。
结论
衰弱在接受Impella MCS的患者中很常见，并且与再入院率升高和再入院期间的不良结局相关。
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