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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Association Between Frailty and 30-day Unplanned Readmission After Hospitalization for Heart Failure: Results from Nationwide Readmissions Database

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      Purpose

      Frailty is associated with adverse hospital outcomes in heart failure (HF) patients. This study examines the association between frailty, readmission, and other relevant hospital outcomes using a national database.

      Methods

      This is a retrospective analysis of the Nationwide Readmissions Database from 2010 to 2014. Patients ≥65 years of age admitted for HF were included in the study. We used the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. The primary outcome of the study was 30-day unplanned readmission rate.

      Results

      A total of 819,854 patients were admitted for HF, of which 63,302 (7.7%) were frail. Frail patients, 22,382 (35.4%) experienced unplanned readmission within 30 days after index hospitalization, as compared to non-frail patients, 168,797 (22.3%, P<0.001). Trend analysis showed that the relative decrease rates of unplanned 30-day readmission decreased for both frail (7.8%) and non-frail (6.9%) patients during the study period. Among HF patients who experienced unplanned 30-day readmission, mortality rates (16.2% versus 8.2%, P<0.001) and hospitalization cost ($13,616 versus $9,876, P<0.001) were higher among frail patients, compared to non-frail patients. Besides HF, most common reasons for unplanned 30-day readmission among frail HF patients were septicemia (11.2%), and acute renal failure (5.1%). Regression analysis showed that the risk for unplanned 30-day readmission was higher in patients with frailty (OR, 1.18; 95% CI, 1.14-1.22). Other risk factors for unplanned 30-day readmission were comorbidity index >3, AMI, CAD, arrhythmia, diabetes mellitus, cancer, chronic lung disease, chronic renal disease, liver disease, fluid and electrolyte disorder, anemia, coagulation disorder, and vasopressor use.

      Conclusion

      Frailty among elderly patients hospitalized for HF is associated with increased readmission, mortality, and cost. Identifying frailty in this population could improve quality of care and decrease hospital burden.