Dataset Information

Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients.

ABSTRACT:

Background

Frailty increases the adverse outcomes of clinical heart failure; however, the relationship between frailty and stage-B heart failure (SBHF) remains unknown. We aimed to explore the epidemiology and predictive value of frailty in older adults with SBHF.

Methods

A prospective cohort of SBHF inpatients aged 65?years or older who were hospitalized between September 2018 and February 2019 and were followed up for 6?months were included. SBHF was defined as systolic abnormality, structural abnormality (left ventricular enlargement, left ventricular hypertrophy, wall motion abnormalities, valvular heart disease), or prior myocardial infarction. Frailty was assessed by the Fried frailty phenotype. Multivariable Cox proportional hazards regression was used to explore the independent risk and prognostic factors.

Results

Data of 443 participants (age: 76.1?±?6.79?years, LVEF: 62.8?±?4.92%, men: 225 [50.8%], frailty: 109 [24.6%]) were analyzed. During the 6-month follow-up, 83 (18.7%) older SBHF inpatients experienced all-cause mortality or readmission, and 29 (6.5%) of them developed clinical HF. Frail individuals had a 1.78-fold (95%CI: 1.02-3.10, P =?0.041) higher risk of 6-month mortality or readmission and a 2.83-fold (95%CI 1.24-6.47, P =?0.014) higher risk of developing clinical HF, independent of age, sex, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide level.

Conclusions

Frailty is common in older SBHF inpatients and should be considered to help identify individuals with an increased risk of mortality or readmission, and developing clinical HF.

Trial registration

ChiCTR1800017204 .

SUBMITTER: Zheng PP

PROVIDER: S-EPMC7885474 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients.

Zheng Pei-Pei PP Yao Si-Min SM He Wei W Wan Yu-Hao YH Wang Hua H Yang Jie-Fu JF

BMC geriatrics 20210216 1

<h4>Background</h4>Frailty increases the adverse outcomes of clinical heart failure; however, the relationship between frailty and stage-B heart failure (SBHF) remains unknown. We aimed to explore the epidemiology and predictive value of frailty in older adults with SBHF.<h4>Methods</h4>A prospective cohort of SBHF inpatients aged 65 years or older who were hospitalized between September 2018 and February 2019 and were followed up for 6 months were included. SBHF was defined as systolic abnormal ...[more]

PMID: 33593292

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Project description:BACKGROUND:Hospital readmission is considered an adverse health outcome in older people, adding additional pressure on clinical resources within health care services. Despite numerous studies on risk factors for readmissions, studies find different strengths of respective determinants and there is a need to explore and identify patterns of risk factors in larger cohorts. OBJECTIVE:Exploring and identifying patterns of risk factors for acute, all-cause 30-day readmission in a Danish cohort of patients aged 65+. DESIGN:Register-based cohort study using individual-level linkable information on demographics, social determinants, clinical conditions, health care utilization, and provider determinants obtained from primary and secondary health care. PARTICIPANTS:Historic cohort of 1,267,752 admissions in 479,854 patients, aged 65+, discharged from Danish public hospitals from January 2007 to September 2010. MAIN MEASURES:We included patient-level variables and admission-level variables. Outcome was acute, all-cause 30-day readmission. Data was analyzed by univariable and multivariable logistic regression. Strength of associations was analyzed using Wald test statistics. Receiver operating characteristic (ROC) analysis was used for quantification of predictive ability. For validation, we used split-sample design. KEY RESULTS:Acute admission and number of days since previous hospital discharge were factors strongly associated with readmission. Patients at risk of future readmission suffered from comorbidity, consumed more drugs, and were frequent users of in- and outpatient health care services in the year prior to the index admission. Factors related to index admission were only weakly associated with readmission. The predictive ability was 0.709 (0.707-0.711) for acute readmission. CONCLUSIONS:In a general population of older people, we found that pre-hospital factors rather than hospital factors account for increased risk of readmission and are dominant contributors to predict acute all-cause 30-day readmission. Therefore, risk for excess readmission should be shared across sectors and focus the care trajectory over time rather than distinct care episodes.

Project description:ImportanceScarce data are available on the association of mineralocorticoid receptor antagonist (MRA) use with outcomes in acute decompensated heart failure (ADHF).ObjectiveTo investigate the association of MRA use with all-cause mortality and hospital readmission in patients with ADHF.Design, setting, and participantsThis cohort study examines participants enrolled in the Kyoto Congestive Heart Failure (KCHF) registry, a physician-initiated, prospective, multicenter cohort study of consecutive patients admitted for ADHF, between October 1, 2014, and March 31, 2016, into 1 of 19 secondary and tertiary hospitals throughout Japan. To balance the baseline characteristics associated with the selection of MRA use, a propensity score-matched cohort design was used, yielding 2068 patients. Data analysis was conducted from April to August 2018.ExposuresPrescription of MRA at discharge from the index hospitalization.Main outcomes and measuresComposite of all-cause death or heart failure hospitalization after discharge.ResultsAmong 3717 patients hospitalized for ADHF, 1678 patients (45.1%) had received MRA at discharge and 2039 (54.9%) did not. After propensity score matching, 2068 patients (with a median [interquartile range] age of 80 [72-86] years, and of whom 937 [45.3%] were women) were included. In the matched cohort (n = 1034 in each group), the cumulative 1-year incidence of the primary outcome was statistically significantly lower in the MRA use group than in the no MRA use group (28.4% vs 33.9%; hazard ratio [HR], 0.81; 95% CI, 0.70-0.93; P = .003). Of the components of the primary outcome, the cumulative 1-year incidence of heart failure hospitalization was significantly lower in the MRA use group than in the no MRA use group (18.7% vs 24.8%; HR, 0.70; 95% CI, 0.60-0.86; P < .001), whereas no difference in mortality was found between the 2 groups (15.6% vs 15.8%; HR, 0.98; 95% CI, 0.82-1.18; P = .85). No difference in all-cause hospitalization was observed between the 2 groups (35.3% vs 38.2%; HR, 0.88; 95% CI, 0.77-1.01; P = .07). In additional analyses that stratified by left ventricular ejection fraction, the association of MRA use with the primary outcome was statistically significant in patients with left ventricular ejection fraction of 40% or greater.Conclusions and relevanceUse of MRA at discharge from ADHF hospitalization did not appear to be associated with lower mortality but was associated with a lower risk of heart failure readmission. This finding suggests that MRA treatment at discharge may have minimal, if any, clinical advantages.

Project description:BackgroundWe aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD).MethodsA single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve.ResultsA total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P < 0.001) and a lower education level (P < 0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at 6 months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06-2.82, P = 0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27-4.91, P = 0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to 6 months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60-0.71), and the AUC for men was 0.71 (95% CI: 0.63-0.78), while that for women was 0.60 (95% CI: 0.51-0.69).ConclusionsAccounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term.Trial registrationChiCTR1800017204; date of registration: 07/18/2018.

Project description:BackgroundParallel to growth of aging and obese populations, the prevalence of metabolic diseases is rising. How body mass index (BMI) relates to frailty and mortality across frailty levels is controversial. We examined the associations of high BMI with frailty and mortality and explored the effects of percent body fat on these associations.MethodsWe included 29,937 participants aged ≥50 years from the 2001-2006 National Health and Nutrition Examination Survey (NHANES) cohorts (N=6062; 53.7% females) and from wave 1 (2004) of Survey of Health, Ageing and Retirement in Europe (SHARE) (N=23,875; 54% females). BMI levels were categorized as: normal: 18.5-24.9 kg/m2, overweight: 25.0-29.9, obese grade 1: 30.0-34.9, and obese grade 2 or 3: >35.0. A frailty index (FI) was constructed excluding nutrition-related items: 36 items for NHANES and 57 items for SHARE. We categorized the FI using 0.1-point increments: FI ≤ 0.1 (non-frail), 0.1 < FI ≤ 0.2 (very mildly frail), 0.2 < FI ≤ 0.3 (mildly frail), and FI > 0.3 (moderately/severely frail). Percent body fat was measured using DXA for NHANES participants. All-cause mortality data were obtained until 2015 for NHANES and 2017 for SHARE to estimate 10-year mortality risk. All analyses were adjusted for age, sex, educational, marital, employment, and smoking statuses.ResultsMean age of participants was 63.3±10.2 years for NHANES and 65.0±10.0 years for SHARE. In both cohorts, BMI levels ≥25 kg/m2 were associated with higher frailty, compared to normal BMI. In SHARE, having a BMI level greater than 35 kg/m2 increased mortality risk in participants with FI≤0.1 (HR 1.31, 95%CI 1.02-1.69). Overweight participants with FI scores >0.3 were at lower risk for mortality compared to normal BMI [NHANES (0.79, 0.64-0.96); SHARE (0.71, 0.63-0.80)]. Higher percent body fat was associated with higher frailty. Percent body fat significantly mediated the relationship between BMI levels and frailty but did not mediate the relationship between BMI levels and mortality risk.ConclusionsBeing overweight or obese is associated with higher frailty levels. In this study, we found that being overweight is a protective factor of mortality in moderately/severely frail people and obesity grade 1 may be protective for mortality for people with at least a mild level of frailty. In contrast, obesity grades 2 and 3 may be associated with higher mortality risk in non-frail people. The relationship between BMI and frailty is partially explained by body fat.

Dataset Information

Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients.

Background

Methods

Results

Conclusions

Trial registration

Publications

Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients.

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