Frailty May Increase Hospital Readmission Risk Among Patients With Heart Failure

Both women and men have a greater chance of 90-day hospital readmission when they are considered to be in frail condition from heart failure (HF), according to a study from Korea recently published in European Journal of Cardiovascular Nursing.

This risk, however, is higher in women who are in frail condition, explained the authors, whose study “aimed to examine the 90-day hospital readmission rates and gender differences in the impact of frailty on 90-day hospital readmission in HF patients.”

Decreasing readmission is a major priority in Korea, but there is a lack of data in this area, and frail status is not a routine measure in patients with HF. “To the best of our knowledge, this is the first study reporting that frailty is a significant risk factor for 90-day hospital readmission in both men and women with HF,” the authors noted.

Hospital discharge records of 110 women and 169 men were retrospectively examined, and frailty was assessed via the Korean FRAIL scale, which covers 5 domains, each measured on a scale of 0 (best, or robust) to 5 (worst, or frail): fatigue, resistance, ambulation, number of illnesses, and weight loss. Patients had to have received a diagnosis of HF between January 2017 and December 2018 to be included in the analysis, with readmission data collected through April 2019.

An overall 32.3% of the study patients were considered frail.

More women in the study were considered frail compared with the men, at 54.4% vs 45.6%, and they were shown to have a 52.7% higher risk of 90-day hospital readmission compared with the men: Their adjusted odds ratio was 6.72 (95% CI, 1.41-32.09) vs 4.40 (95% CI, 1.73-11.17).

Still, the prevalence of 90-day readmission was higher in the men, at 27.8% vs 22.7%.

The mean (SD) patient age was 68.55 (0.62) years; mean duration of HF diagnosis, 3.06 (0.17) years; 52.3% had New York Heart Association (NYHA) Class I disease; and the mean left-ventricular ejection fraction was 52.86% (0.71%), indicating that most had HF with preserved ejection fraction.

The study also examined possible factors contributing to frailty status, to see if they differed between the men and women in the study, and they saw both variation and overlap:

• For men, these factors were:
  • Older age (χ² = 12.42; P < .001)
  • Less education (χ² = 7.48; P = .006)
  • Unemployed status (χ² = 9.67; P = .002)
  • Low-income status (χ² = 5.91; P = .015)
  • NYHA Class I disease (χ² = 48.26; P < .001)
  • Comorbid diabetes (χ² = 4.01; P = .050)
  • Comorbid chronic kidney disease (χ² = 5.07; P = .039)
  • Digoxin use (χ² = 5.33; P = .028)
• For women, these factors were:
  • Older age (χ² = 9.81; P = .002)
  • Unemployed status (χ² = 6.12; P = .018)
  • Low-income status (χ² = 7.74; P = .008)
  • NYHA Class I disease (χ² = 48.98; P < .001)
  • Atrial fibrillation (χ² = 8.11; P = .007)
  • Diuretic use (χ² = 7.50; P = .007)

Readmission was also demonstrably higher in both the women (χ² = 24.73; P < .001) and men (χ² = 25.46; P < .001) when comparing frailty status with prefrailty status.

The authors highlighted 3 areas for future investigation:

1. Are routine frailty assessments effective for evaluating adverse outcomes among patients with HF?
2. Can frailty status inform patient-centered strategies at all stages in the disease trajectory?
3. Are separate care approaches needed for men and women?

“Our findings emphasize the presence of a complex overlap between frailty and HF, which may increase the risk of hospital readmission,” they concluded. “Further studies are needed to identify the differences in the factors influencing frailty status between men and women such as multi-centre prospective cohort studies and interaction effect of frailty and gender on hospital readmission among older HF patients.”

Reference

Son Y-J, Shim DK, Seo EK, Won MH. Gender differences in the impact of frailty on 90-day hospital readmission in heart failure patients: a retrospective cohort study. Eur J Cardiovasc Nurs. Published online January 6, 2021. doi:10.1093/eurjcn/zvaa028