Hospital Frailty Risk Score Predicts Long-Term Hospital Readmissions in Very Old Patients with Heart Failure

Background: Heart failure (HF) is a highly prevalent condition among older adults, with a remarkable rate of re-hospitalization due to exacerbations. Frailty is strongly correlated with negative outcomes and might reveal patients in need of tailored follow-up. The aim of the study is to evaluate the predictive role of frailty in long-term re-hospitalization risk. Methods: In this prospective study, older adults hospitalized in an acute geriatric ward due to HF were included. Frailty was assessed at admission time by hospital frailty risk score (HFRS). Any hospital readmission was investigated up to one year after discharge. Patients were divided into tertiles upon receiving their HFRS, and readmission risk was evaluated by Cox regression models. Results: Among 213 patients (mean age 86 ± 7 years, 98, 46% male), 155 were frail according to HFRS. A total of 117 subjects were readmitted to hospital within one year after discharge. A Cox regression model showed that, even after adjustment for multiple selected variables, there was a significant increasing trend in the readmission risk across HFRS tertiles: compared with the lowest tertile, patients in the middle tertile had an risk of readmission of 1.29 (95% C.I.: 1.03-1.61), while those in the highest tertile showed a further 1.29 increase. Conclusions: Among patients with HF, long-term re-hospitalizations might be largely influenced by a previous state of frailty. HFRS is a feasible and broadly applicable tool that could be included in routine clinical practice to promptly identify heart failure patients at higher risk of readmission, in order to plan tailored assistance measures.