Optimising the ISAR-HP to screen efficiently for functional decline in older patients

Area of Science:

• Geriatric Medicine
• Internal Medicine
• Hospital Medicine

Background:

• The Identification of Seniors At Risk-Hospitalised Patients (ISAR-HP) is a guideline-recommended frailty indicator for geriatric assessment.
• Previous research indicates the conventional ISAR-HP cut-off score leads to misclassification of many patients.
• Optimizing ISAR-HP's predictive value is crucial for accurate risk stratification in older adults.

Purpose of the Study:

• To optimize the predictive value of the ISAR-HP by evaluating different cut-off scores.
• To assess the performance of the ISAR-HP in identifying functional decline or mortality in acutely hospitalised older patients.

Main Methods:

• Prospective follow-up study conducted in two Dutch hospitals.
• Inclusion of acutely hospitalised patients aged 70 years and older.
• Collection of baseline demographics, illness severity, geriatric measurements, and ISAR-HP scores; primary outcome was functional decline or mortality within 90 days.

Main Results:

• 765 older patients were included; 36.1% experienced functional decline or mortality.
• The conventional ISAR-HP cut-off (≥ 2) identified 56.5% as high risk, with a Positive Predictive Value (PPV) of 0.49.
• Increasing the cut-off to ≥ 4 identified 26.8% as high risk, with a marginally improved PPV of 0.55.

Conclusions:

• The conventional ISAR-HP cut-off (≥ 2) overestimates the risk of functional decline or mortality in hospitalised older adults.
• Raising the ISAR-HP cut-off to 4 offers only a marginal improvement in predictive accuracy.
• Careful consideration of ISAR-HP cut-offs is needed for efficient screening and intervention planning.