Abstract
Introduction: The burden of frailty is high among older patients hospitalized for heart failure (HF); however, little is known about frailty in younger patients with HF. The purpose of this study is to investigate the prevalence of frailty and its association with clinical outcomes in middle aged adults hospitalized for HF. Methods: We included patients <65 years old hospitalized for acute HF within a university affiliated network between 2015 to 2020. The Hospital Frailty Index was used to assess frailty risk based on ICD-10 codes. Patients were categorized into low (score < 5), intermediate (score 5-15) and high (score >15) risk for frailty. We investigated the association between frailty status and clinical outcomes (prolonged hospitalization [length of stay ≥ 7 day]), 30d-readmission, and 30d-mortality using multivariable logistic regression models. Results: Out of 10,170 patients (mean age 51.8±10.5 years) who were hospitalized for HF, 1129 (11.1%) were categorized as low, 3718 (36.6%) as intermediate, and 5323 (52.3%) as high risk for frailty. The proportion of patients experiencing prolonged hospitalization, 30-day readmission, and 30-day mortality was highest in the high-risk frailty group (Table). Compared to patients with low-risk frailty status, high-risk frailty status was significantly associated with prolonged hospitalization (adjusted odds ratio [aOR] 9.2, 95% Confidence Interval [CI] 7.3 - 11.5), 30-day readmission (aOR 3.7, 95% CI 2.9 - 4.7), and 30-day mortality (aOR 6.1, 95% CI 3.2 - 11.5). Compared to low risk frailty status, intermediate risk frailty status was associated with prolonged hospitalization (aOR 3.7, 95% CI 3.0 - 4.7) and 30-day mortality (aOR 3.4, 95% CI 1.8 - 6.6), but not 30-day readmission (aOR 1.34, 95% CI 0.88 - 2.05). Conclusions: Among middle aged adults hospitalized for HF, there is a high burden of frailty. We found a significant association between high-risk frailty status and worse clinical outcomes in this age group.
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