(741) Impact of Frailty on Mortality, Length of Stay, and Resource Utilization after Advanced Heart Failure Therapy

PurposeFrailty has been associated with inferior outcomes in patients with advanced heart failure (HF) therapy, which includes heart transplantation and Left Ventricular Assist Device implantation (LVAD). There is a lack of data to assess if hospital frailty risk score (HFS) is associated with worse outcomes in such populations.MethodsOur retrospective study used Nationwide Readmission Database (NRD). First, we extracted all cases older than 18 years that received advanced heart failure therapy during the index admission between Jan-Jun for 2016-2019 to allow for a 6-month follow-up. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4.ResultsWe identified 14,837 discharges who received advanced HF therapy. HFS <5 was present in 25% (n=3,753) of the cohort. Patients with intermediate-high frailty risk score (HFS<=5) were slightly older than those with low frailty risk (HFS<5) with a mean age of 56 years vs. 54 years, and had fewer women (23% vs. 27%, p<0.001). Patients with HFS>5 had a higher prevalence of diabetes mellitus, cerebrovascular disease (CBVD), acute encephalopathy, anemia, coagulopathy, peripheral vascular disease (PVD), and chronic (liver and renal) diseases (p<0.001). Also, they had higher inpatient mortality during index admission (11% vs. 3%, p<0.001), and all-cause 6-month readmission rates (52% vs. 50%, p=0.05). Even after adjusting for age, gender, CBVD, acute encephalopathy, PVD, coagulopathy, malnutrition, and chronic (liver and renal) diseases, the HFS>5 continued to be associated with higher inpatient mortality compared to those with HFS<5 (OR 2.27[1.69-3], p<0.001). Length of stay had a linear trend with HFS (mean of 25 days for HFS<5 vs. 37 days for HFS 5-10 vs. 50 days for HFS 10-15 vs. 61 days for HFS>15, p<0.001).ConclusionIn patients receiving advanced HF therapy, hospital frailty risk score is associated with worse outcomes. Frailty has been associated with inferior outcomes in patients with advanced heart failure (HF) therapy, which includes heart transplantation and Left Ventricular Assist Device implantation (LVAD). There is a lack of data to assess if hospital frailty risk score (HFS) is associated with worse outcomes in such populations. Our retrospective study used Nationwide Readmission Database (NRD). First, we extracted all cases older than 18 years that received advanced heart failure therapy during the index admission between Jan-Jun for 2016-2019 to allow for a 6-month follow-up. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4. We identified 14,837 discharges who received advanced HF therapy. HFS <5 was present in 25% (n=3,753) of the cohort. Patients with intermediate-high frailty risk score (HFS<=5) were slightly older than those with low frailty risk (HFS<5) with a mean age of 56 years vs. 54 years, and had fewer women (23% vs. 27%, p<0.001). Patients with HFS>5 had a higher prevalence of diabetes mellitus, cerebrovascular disease (CBVD), acute encephalopathy, anemia, coagulopathy, peripheral vascular disease (PVD), and chronic (liver and renal) diseases (p<0.001). Also, they had higher inpatient mortality during index admission (11% vs. 3%, p<0.001), and all-cause 6-month readmission rates (52% vs. 50%, p=0.05). Even after adjusting for age, gender, CBVD, acute encephalopathy, PVD, coagulopathy, malnutrition, and chronic (liver and renal) diseases, the HFS>5 continued to be associated with higher inpatient mortality compared to those with HFS<5 (OR 2.27[1.69-3], p<0.001). Length of stay had a linear trend with HFS (mean of 25 days for HFS<5 vs. 37 days for HFS 5-10 vs. 50 days for HFS 10-15 vs. 61 days for HFS>15, p<0.001). In patients receiving advanced HF therapy, hospital frailty risk score is associated with worse outcomes.