The hospital frailty risk score in patients with heart failure is strongly associated with outcomes but less so with pharmacotherapy

Abstract

Background Although frailty is known to be an important prognostic factor in heart failure (HF), HF risk‐adjustment models do not incorporate frailty measures and the interplay between frailty, age and pharmacotherapy is unclear. Objectives To explore the relationships between frailty, pharmacotherapy and outcomes in heart failure (HF). Methods Retrospective cohort study of all adults in Alberta, Canada hospitalized for the first time for HF between 2004 and 2016. Frailty was defined using the Hospital Frailty Risk Score (HFRS). Results In 26 626 patients (mean age 77.4 years), the 8887 (33.4%) defined as frail (HFRS ≥ 5) were older, had higher Charlson scores and more prior emergency department visits or hospitalizations. The HFRS and the Charlson Score were only weakly correlated (r = 0.35). Whilst more common in older patients (41.4% of patients 80 or older), frailty was present in 22.4% of patients younger than 65. Frail patients had longer lengths of stay and worse outcomes postdischarge, but adding the HFRS to age, sex and Charlson score did not improve prediction of events (c‐statistics 0.69 for 30‐day mortality after admission, and 0.54 for 30‐day readmission/ED visit/or death after discharge). Frail patients younger than 65 were significantly more likely than nonfrail patients 80 or older to be prescribed high‐dose evidence‐based HF therapies (27.1% vs. 22.2%, P = 0.003). Conclusion Although the HFRS reflects aspects of frailty that patient age and Charlson scores do not, the addition of the HFRS to standard risk prediction equations provides little additional information. Prescribing practices correlate more with patient age than frailty status.

Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales

“…A fair to moderate level of agreement between frailty assessment methods is not uncommon and our very recent direct comparison of hospitalised patients 65 years and over, also identified low correlation between eFI and HFRS 13 , 28 . Consistent with previous studies, we observed significantly poorer outcomes with higher categories of frailty for eFI and HFRS among hospitalised patients – including those admitted to ICU—with the HFRS discriminating to a slightly greater degree than eFI 5 , 29 .…”

“…Whilst CCI is derived using ICD-10 codes of 17 comorbidities, the HFRS was developed giving weighting to 109 frailty-related ICD-10 codes depending on their association with frailty 13 , 21 . In a recent study in heart failure patients only moderate agreement was found between CCI and HFRS, although both scores were predictive of outcome 29 .…”

The prevalence and importance of frailty in heart failure with reduced ejection fraction – an analysis of PARADIGM‐HF and ATMOSPHERE

“…Two recent studies using the same FI (the Hospital Frailty Risk Score) in patients hospitalized with HF have shown that frailty is also associated with higher rates of short and long-term mortality after discharge; a third confirmed the distinction between frailty and comorbidity by demonstrating a poor correlation between the Hospital Frailty Risk Score and the Charlson Comorbidity Index. [42][43][44] Frailty may also reduce a patient's ability to self-care and impair adherence because of associated cognitive impairment. [36][37][38] Polypharmacy increased with increasing frailty, not only causing concerns about adherence but also about drug-related adverse effects and interactions.…”

Frailty Assessed by Administrative Tools and Mortality in Patients With Pneumonia Admitted to the Hospital and ICU: a Population-based Data-linkage Study

“…Whilst CCI is derived using ICD-10 codes of 17 comorbidities, the HFRS was developed giving weighting to 109 frailty-related ICD-10 codes depending on their association with frailty 1321 . In a recent study in heart failure patients only moderate agreement was found between CCI and HFRS, although both scores were predictive of outcome 29 .…”