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CC BY 4.0 · Avicenna J Med
DOI: 10.1055/s-0044-1801349
Original Article

Impact of Frailty on Inpatient Mortality and Resource Utilization for Primary Pulmonary Hypertension

Rayaan Rauf 
1   School of Medicine, University of Missouri–Kansas City, Kansas City, Missouri, United States
,
Cheryl A. Gibson
2   Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States
,
Mohamad Alhoda Mohamad Alahmad
2   Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States
› Author Affiliations Funding Source This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Background Frailty has been associated with inferior outcomes in patients with primary pulmonary hypertension (PPH). There is a lack of national data to assess if hospital frailty risk score (HFRS) is associated with worse inpatient outcomes in PPH.

Methods Our retrospective study used the Nationwide Readmission Database (NRD). First, we extracted all cases older than 18 years who were discharged with a principal diagnosis of PPH between January and November 2016 to 2019 to allow for a 30-day follow-up. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4.

Results We identified 4,555 cases. HFRS <5 was present in 56% (n = 2,555) of the cohort. Patients with an intermediate-to-high frailty risk score (HFRS ≥5) were older than those with a low frailty risk score (HFRS <5), with a mean age of 61 versus 54 years (p < 0.01), and had slightly fewer women (75 vs. 78%, p = 0.09). Patients with HFRS >5 had a higher prevalence of dementia, depression, diabetes mellitus, malignancy, acute encephalopathy, coagulopathy, heart failure, and chronic (liver and renal) diseases (p < 0.01). Also, they had higher inpatient mortality during index admission (14 vs. 2%, p < 0.001), and all-cause 30-day readmission rates (38 vs. 33%, p = 0.01). Univariate analysis suggests a positive correlation between the degree of frailty and the odds of inpatient mortality (referenced to HFRS <5). The HFRS 5 to 10 group has an odds ratio (OR) of 5 (95% confidence interval [CI]: 3.3–8), the HFRS 10 to 15 group has an OR of 14 (95% CI: 8–23), and the HFRS >15 group has an OR of 20 (95% CI: 9–45). Even after adjusting for age, gender, and significant comorbidities, the single most important factor associated with higher odds of inpatient mortality was HFRS >5 (OR: 5.5 [95% CI: 3.7–8.3], p < 0.001) followed by acute myocardial infarction, acute encephalopathy, heart failure, chronic liver disease, and malnutrition. Length of stay had linear trend with HFRS (mean of 6 days for HFRS <5 vs. 11 days for HFRS 5–10 vs. 19 days for HFRS >10, p < 0.001).

Conclusion Adverse inpatient outcomes correlate with the severity of HFRS in PPH.

Keywords

frailty - primary pulmonary hypertension - inpatient mortality

Previous Presentation

Rauf R and Al-Ahmad M. Impact of Frailty on Inpatient Mortality and Resource Utilization for Primary Pulmonary Hypertension [Conference Presentation], Society for Cardiovascular Angiography & Interventions 2024 Scientific Sessions, Long Beach, CA; May 2, 2024.


Authors' Contribution

M.A.M.A. contributed to the conceptualization, investigation, methodology, formal analysis, data curation, visualization, and project administration and supervision. R.R. contributed to the investigation, visualization, and drafting of the original manuscript. C.G. and R.R. reviewed and edited the manuscript.


Supplementary Material



Publication History

Article published online:
08 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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