Association of Hospital Admission Risk Profile Score with Mortality in Hospitalized Older Adults.

Stephen K Liu,John N Mecchella,Marshall Ward,Rebecca Masutani,John A Batsis,Stephen J Bartels,Justin Montgomery

doi:10.1093/geroni/igx007

Stephen K Liu, John N Mecchella + Show 5 more

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https://doi.org/10.1093/geroni/igx007

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ObjectivesTo evaluate the association of the Hospital Admission Risk Profile (HARP) score with mortality after discharge in a population of hospitalized older adults.DesignRetrospective cohort study.ParticipantsHospitalized patients aged 70 years or older.MeasurementsPatient age at the time of admission, modified Folstein Mini-Mental Status Exam score, and self-reported instrumental activities of daily living 2 weeks prior to admission were used to calculate a HARP score. The primary outcome assessed was overall mortality up to 365 days after hospital discharge. Cox proportional hazard analyses evaluated the association between HARP score and mortality adjusting for age, sex, and comorbidities associated with increased mortality.ResultsOf the 474 patients, 165 (34.8%) had a low HARP score, 177 (37.4%) had an intermediate, and 132 (27.8%) had a high score. HARP score was not associated with differences in 30-day readmission rates. High HARP score patients had higher mortality when compared to patients with low HARP scores at all time frames (30 days: 12.9% vs 1.8%, p < .05; 90 days: 19.7% vs 4.8%, p < .05; 365 days: 34.8% vs 16.9%, p < .05). In fully adjusted Cox proportional models, patients with high HARP scores had a 3.5 times higher odds of mortality when compared to low HARP score patients.ConclusionThe HARP score is a simple and easy to use instrument that identifies patients at increased risk for mortality after hospital discharge. Early identification of patients at increased risk for mortality has the potential to help guide treatment decisions following hospital discharge and provides additional information to providers and patients for shared decision making and may help in clarifying and achieving patient and family goals of care.

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Background and ObjectivesThe acute hospitalization of older adults can represent a major health transition point which provides an opportunity to identify issues and values which matter most to a patient and clarify goals of care following hospital discharge
Patients with high Hospital Admission Risk Profile (HARP) scores on admission were found to have a 3.5 times greater risk of mortality 1 year after hospital discharge when compared to low HARP score patients
After adjustment for age and comorbidities, we found that impairment in cognition was independently associated with an increased mortality after discharge, while age and impairment in instrumental activities of daily living (IADL) function were not

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The acute hospitalization of older adults can represent a major health transition point which provides an opportunity to identify issues and values which matter most to a patient and clarify goals of care following hospital discharge. Others, including the Charlson Comorbidity Score and the Acute Physiology and Chronic Health Evaluation (APACHE) Score, use patient information that is not typically used or obtained in clinical care for nonintensive care unit patients (i.e., blood pH, arterial partial pressure oxygenation [PaO2], or serum albumin levels) or involve the summation of multiple patient comorbidities that may not be readily available within the medical record or would be time consuming to perform in a clinical setting (Christensen, Johansen, Christiansen, Jensen, & Lemeshow, 2011; de Gelder et al, 2016; Martinez-Velilla, Cambra-Contin, & Ibanez-Beroiz, 2014; Walter et al, 2001)

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