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Impact of Frailty on Emergency Department Encounters for Cardiovascular Disease: A Retrospective Cohort Study

Balamrit Singh Sokhal1, Andrija Matetić2, Abhishek Abhishek3

  • 1School of Medicine; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom.

The American Journal of Cardiology
|September 14, 2023
PubMed

Insights

Frailty significantly impacts emergency department visits for cardiovascular diseases (CVDs). High-risk frail patients experience different CVD patterns and increased overall mortality, particularly with atrial fibrillation and heart failure.

Area of Science:

  • Cardiovascular Medicine
  • Geriatrics
  • Public Health

Background:

  • Limited data exist on how frailty status influences emergency department (ED) encounters for cardiovascular diseases (CVDs) and their outcomes.
  • Understanding these variations is crucial for targeted interventions and improved patient care in acute CVD settings.

Purpose of the Study:

  • To investigate whether the causes of ED encounters for selected CVDs and associated clinical outcomes differ based on patient frailty status.
  • To analyze the association between frailty and ED mortality across various CVD presentations.

Main Methods:

  • Utilized the US Nationwide ED Sample, analyzing 8,577,028 selected CVD encounters (AMI, ischemic stroke, AF, HF, PE, cardiac arrest, hemorrhagic stroke).
  • Stratified encounters by Hospital Frailty Risk Score (HFRS) into low (<5), intermediate (5-15), and high (>15) risk groups.
  • Employed logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for ED mortality.

Main Results:

  • High-risk frail patients (4.8%) showed distinct CVD patterns, with ischemic stroke most common, unlike lower-risk groups where AF, AMI, and HF predominated.
  • Compared to low-risk patients, high-risk individuals had decreased ED mortality but significantly increased overall mortality across most CVD encounters (p <0.001).
  • The strongest association with overall mortality was seen in high-risk patients with atrial fibrillation (aOR 27.14) and heart failure (aOR 13.71).

Conclusions:

  • Patients presenting to the ED with acute CVD exhibit a considerable frailty burden, with CVD types varying by frailty level.
  • Frailty is a significant predictor of increased all-cause mortality in patients experiencing most types of acute cardiovascular events.

Keywords:
cardiovascular diseaseemergency departmentfrailtymortality

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