Hospital readmission and mortality associations to frailty in hospitalized patients with coronary heart disease

Abstract

Background: Frailty is associated with poor quality outcomes. Objective: To examine associations between frailty and hospital readmission or mortality in Coronary Heart Disease (CHD). Methods: Retrospectively assessed the 2016 US Nationwide Readmissions Database (NRD) including adults ≥ 65 years with pre-existing CHD. A validated Hospital Frailty Risk Score (HFRS) using ICD-10-CM codes identified frailty risk. Outcomes included: Readmission (30-day and subsequent readmission after index event) and in- hospital morality (during index event, readmission, and at 30-day readmission). Results: Among 1.1 million eligible patients, low, intermediate, and high frailty risk accounted for 48.9%, 46.7%, and 4.4% of the sample. Compared to low frailty risk, intermediate and high frailty risk showed significantly higher overall readmission rates (40.9% vs. 31.4%, 41.7% vs. 31.4%) and 30-day readmission rates (21.9% vs. 15.7%, 23.5% vs. 15.7%), respectively. After adjustment, higher in-hospital mortality and readmission rates were associated with higher frailty risk. The associations between in-hospital mortality and frailty depended on the presence of acute coronary syndrome. Conclusions: Readmission and mortality rates increased proportionally to the level of frailty risk in older adults with CHD. CHD, frailty risk, and older age profoundly negatively impact health outcomes and increases risk of death and readmission.