Title: Frailty is an independent risk factor for short-term mortality in older patients hospitalized with acute decompensated heart failure
Clinical Question: What is the effect of frailty on 30-day mortality in non–severely disabled older patients with acute decompensated heart failure?
Background: Existing research highlights the worsened short-term prognosis in older patients with acute decompensated heart failure, but has not examined if frailty is a specific independent risk factor for 30-day mortality in those without severe functional dependence.
Study Design: Retrospective secondary analysis of a prospective observational multicenter cohort study.
Setting: Three Spanish EDs.
Synopsis: In 465 patients age 65 and older with acute decompensated heart failure who did not have an ST-segment elevation myocardial infarction, severe functional dependence, or dementia, 36.3% were categorized as frail on a validated performance status scoring system. Frail patients had a higher 30-day mortality rate than did non-frail patients (13.0% versus 4.1% in non-frail patients). Frailty was independently associated with a 30-day mortality (hazard ratio = 2.5, P = .047).
The major limitations of this study are that the researchers did not report how many patients were discharged versus admitted from the ED and they did not stratify short-term mortality attributable to frailty by degree of medical comorbidity.
Bottom Line: Frailty is common in older patients with acute decompensated heart failure and is also an independent risk factor for short-term mortality.
Citation: Martin-Sanchez FJ, Rodriguez-Adrada E, Mueller C, et al. The effect of frailty on 30-day mortality risk in older patients with acute heart failure attended in the emergency department. Acad Em Med. 2017;24(3):298-307.
Dr. Barrett is assistant professor in the division of hospital medicine at the University of New Mexico.
