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Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure

2017; Elsevier BV; Volume: 120; Issue: 7 Linguagem: Inglês

10.1016/j.amjcard.2017.06.059

1879-1913

Francisco Javier Martín‐Sánchez, Esther Rodríguez‐Adrada, María Teresa Vidán, Guillermo García, Juan González del Castillo, Miguel Alberto Rizzi, Aitor Alquézar, Pascual Piñera, Paula Lázaro Aragüés, Pere Llorens, Pablo Herrero, Javier Jacob, Víctor Gil, Cristina Fernández, Héctor Bueno, Òscar Miró, María José Pérez‐Durá, Pablo Berrocal Gil, Òscar Miró, Víctor Gil Espinosa, Carolina Sánchez, Sira Aguiló, Maria Àngels Pedragosa Vall, Alfons Aguirre, Pascual Piñera, Paula Lázaro Aragüés, Miguel Alberto Rizzi Bordigoni, Aitor Alquézar, Fernando Richard, Javier Jacob, Carles Ferrer, Ferrán Llopis, Francisco Javier Martín‐Sánchez, Juan González del Castillo, Esther Rodríguez‐Adrada, Guillermo García, Lucía Salgado, Eduardo Anguita, Julián Sanz‐Ortega, María de los Ángeles Cuadrado Cenzual, Maria Dolores Inés Ortega de Heredia, Pere Llorens Soriano, José María Fernández‐Cañadas, José Manuel Carratalá, Patricia Javaloyes, Pablo Herrero, Iván García, María Fernández Coya, J.A. Sevillano Fernández, Juan Antonio Andueza, Rodofo Romero Pareja, Carmen del Arco, Alfonso Martı́n, Raquel Maria Cardoso Torres, Belén Rodríguez Miranda, Vanesa Sendín Martín, Carlos Bibiano Guillén, Rodrigo Pacheco Puig,

Heart Failure Treatment and Management

The objectives were to determine the impact of frailty and disability on 30-day mortality and whether the addition of these variables to HFRSS EFFECT risk score (FBI-EFFECT model) improves the short-term mortality predictive capacity of both HFRSS EFFECT and BI-EFFECT models in older patients with acute decompensated heart failure (ADHF) atended in the emergency department. We performed a retrospective analysis of OAK Registry including all consecutive patients ≥65 years old with ADHF attended in 3 Spanish emergency departments over 4 months. FBI-EFFECT model was developed by adjusting probabilities of HFRSS EFFECT risk categories according to the 6 groups (G1: non frail, no or mildly dependent; G2: frail, no or mildly dependent; G3: non frail, moderately dependent; G4: frail, moderately dependent; G5: severely dependent; G6: very severely dependent).We included 596 patients (mean age: 83 [SD7]; 61.2% females). The 30-day mortality was 11.6% with statistically significant differences in the 6 groups (p < 0.001). After adjusting for HFRSS EFFECT risk categories, we observed a progressive increase in hazard ratios from groups G2 to G6 compared with G1 (reference). FBI-EFFECT had a better prognostic accuracy than did HFRSS EFFECT (log-rank p < 0.001; Net Reclassification Improvement [NRI] = 0.355; p < 0.001; Integrated Discrimination Improvement [IDI] = 0.052; p ;< 0.001) and BI-EFFECT (log-rank p = 0.067; NRI = 0.210; p = 0.033; IDI = 0.017; p = 0.026). In conclusion, severe disability and frailty in patients with moderate disability are associated with 30-day mortality in ADHF, providing additional value to HFRSS EFFECT model in predicting short-term prognosis and establishing a care plan.