Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure

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The objectives were to determine the impact of frailty and disability on 30-day mortality and whether the addition of these variables to HFRSS EFFECT risk score (FBI-EFFECT model) improves the short-term mortality predictive capacity of both HFRSS EFFECT and BI-EFFECT models in older patients with acute decompensated heart failure (ADHF) atended in the emergency department. We performed a retrospective analysis of OAK Registry including all consecutive patients ≥65 years old with ADHF attended in 3 Spanish emergency departments over 4 months. FBI-EFFECT model was developed by adjusting probabilities of HFRSS EFFECT risk categories according to the 6 groups (G1: non frail, no or mildly dependent; G2: frail, no or mildly dependent; G3: non frail, moderately dependent; G4: frail, moderately dependent; G5: severely dependent; G6: very severely dependent).We included 596 patients (mean age: 83 [SD7]; 61.2% females). The 30-day mortality was 11.6% with statistically significant differences in the 6 groups (p < 0.001). After adjusting for HFRSS EFFECT risk categories, we observed a progressive increase in hazard ratios from groups G2 to G6 compared with G1 (reference). FBI-EFFECT had a better prognostic accuracy than did HFRSS EFFECT (log-rank p < 0.001; Net Reclassification Improvement [NRI] = 0.355; p < 0.001; Integrated Discrimination Improvement [IDI] = 0.052; p ;< 0.001) and BI-EFFECT (log-rank p = 0.067; NRI = 0.210; p = 0.033; IDI = 0.017; p = 0.026). In conclusion, severe disability and frailty in patients with moderate disability are associated with 30-day mortality in ADHF, providing additional value to HFRSS EFFECT model in predicting short-term prognosis and establishing a care plan.

Section snippets

Methods

We performed a retrospective analysis of the Older Acute Heart Failure Key Data (OAK) Registry. This is a prospective observational multicenter cohort study,14 which was approved by the Clinical Ethical Committees of all the participating hospitals.

The OAK Registry prospectively included all patients ≥65 years old with ADHF attended in 3 Spanish EDs (Hospital Clínico San Carlos, Madrid; Hospital Reina Sofía, Murcia; and Hospital de la Santa Creu i Sant Pau, Barcelona) over a 4-month period, in

Results

We selected for the present study 596 of 952 (62.6%) patients consecutively included in the OAK Registry (Figure 1). Comparison between included and nonincluded patients showed significant differences in higher age and frequency of ischemic heart disease, dementia, cardiorespiratory and functional baseline dependence, and lower NT-proBNP levels in the included patients (Supplementary Table 1).

Table 1 shows the characteristics of the patients included in the study. Two hundred and eighty-one

Discussion

The present study shows that frailty and disability have an impact on 30-day mortality in older patients with ADHF attended in EDs. The presence of the frailty phenotype (≥3 Fried criteria) in patients with moderate baseline functional dependence (BI = 60 to 85 points) and the presence of severe disability (BI < 60 points) are factors independently associated with a poor short-term prognosis. These results suggest that the baseline functional status (basic activities of daily living and

List of Investigators of the OAK Registry

María José Pérez-Durá, Pablo Berrocal Gil (Hospital La Fe de Valencia). Óscar Miró, Víctor Gil Espinosa, Carolina Sánchez, Sira Aguiló (Hospital Clinic de Barcelona). Maria Àngels Pedragosa Vall, Alfons Aguirre (Hospital del Mar de Barcelona). Pascual Piñera, Paula Lázaro Aragues (Hospital Reina Sofia de Murcia). Miguel Alberto Rizzi Bordigoni, Aitor Alquezar (Hospital San Pau de Barcelona). Fernando Richard (Hospital de Burgos). Javier Jacob, Carles Ferrer, Ferrán Llopis (Hospital Universitari

Disclosures

FJM-S received advisory/consulting fees from, Novartis, MSD, Pfizer, The Medicine Company, Otsuka, and research grants from the Spanish Ministry of Health and FEDER, Novartis, Abbot, and Orion-Pharma. PLL received advisory/consulting fees from Novartis, MSD, Boehringer Ingelheim, Pfizer and Orion-Pharma and research grants: Abbot, Otsuka, Cardiorentis and Novartis. PH received advisory/consulting fees from Novartis and research grants: Abbot, Otsuka, and Novartis. JJ received

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    Funding: This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER (PI15/00773, PI15/01019, and PI11/01021) and Fundació la Marató de TV3 (2015).

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