45 Frailty at Discharge is a Marker of End-of-Life following Admission with Acute Coronary Syndrome or Acute Heart Failure

Abstract

Background Patients with advanced heart disease who are approaching end-of-life (EoL) rarely receive palliative care. This study evaluated the utility of the Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) in predicting 12 month mortality in patients discharged from hospital following acute coronary syndrome (ACS) or acute heart failure (AHF). Methods 188 unselected consecutive patients admitted to an acute cardiology ward over a 8 week period with either ACS or AHF were assessed prior to discharge using a number of prognostic tools including CFS, GRACE (for ACS), EFFECT (for AHF) and the Gold Standards Framework (GSF) prognostic indicator guide. Unscheduled hospital admissions and all-cause mortality were then documented over a 12 month period of follow-up. Results The presence of frailty (CFS 5–7) had a high sensitivity (83%) and specificity (79%) in predicting 12 month mortality for both ACS and AHF patients. Compared to GSF, the CFS was more sensitive and had higher positive predicting value for 12-month mortality (C–statistic 0.81). The addition of the GRACE or EFFECT score to CFS improved its predictive value only marginally. (C-statistic 0.83). No clear relationship was identified between frailty and risk of unscheduled hospital admissions during follow-up. Conclusion CFS could be used in combination with a disease-specific clinical score (GRACE or EFFECT) at time of discharge from hospital to identify ACS and AHF patients at increased risk of death within 12 months and who may therefore be suitable for end-of-life care.