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Frailty in elderly Medicare recipients hospitalized for acute MI, pneumonia, or heart failure was linked with a greater risk of readmissions and death, a nationwide cohort study found.

In patients hospitalized for acute MI, for example, those with high-risk frailty scores had a threefold greater risk of readmission at 30 days compared with low-risk individuals (adjusted odds ratio [aOR] 3.0, 95% CI 2.9-3.1), reported Robert Yeh, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues,

And these patients were at greater risk of 30-day mortality, measured either from the time of admission (aOR 3.6, 95% CI 3.4-3.8) or from discharge (aOR 4.0, 95% CI 3.7-4.3), as described in .

The authors reported similar 30-day trends for patients hospitalized with pneumonia and heart failure, respectively:

• Readmission: aOR 2.8 (95% CI 2.7-2.9) and aOR 2.9 (95% CI 2.8-3.0)
• Postadmission mortality: aOR 2.5 (95% CI 2.3-2.6) and aOR 3.5 (95% CI 3.4-3.7)
• Postdischarge mortality: aOR 3.0 (95% CI 2.9-3.2) and aOR 3.5 (95% CI 3.3-3.6)

"Unless frailty is adequately captured in risk-adjustment metrics, it is possible that hospitals that care for a higher proportion of frail patients are disproportionately financially penalized for worse outcomes owing to unrecognized comorbidities among the patients they care for, rather than quality of care delivered," Yeh's team wrote.

For their study, high-risk frailty was defined as a Hospital Frailty Risk Score (HFRS) greater than 15, while an HFRS below 5 was low-risk frailty.

Prior research has looked at frailty and its impact on cardiovascular procedures, such as transcatheter aortic valve replacement and heart transplantation, among others, Sean Pinney, MD, of the Mount Sinai Health System in New York City, told MedPage Today. The literature has expanded experts' understanding of what frailty is and the negative impact that frailty has on cardiovascular outcomes, he added.

"As practitioners, we are becoming more aware of the need to identify patients who are frail, to come up with screening systems that are easy to deploy, that are highly accurate, and also provide some actionable information in order to try to allow patients who are frail to become more robust, so that they can prevent rehospitalization in the near future," said Pinney, who was not involved in the study.

In all, Yeh's group evaluated 785,127 Medicare fee-for-service recipients at acute care hospitals using the Centers for Medicare & Medicaid Services (CMS) Medicare Provider Analysis and Review files -- 166,200 who were hospitalized for acute MI, 270,308 for pneumonia, and 348,619 for heart failure. At the time of hospitalization, mean patient age was 79.2. The cohort was 51.3% women and 83.6% white.

Mean HFRS was 10.8 for patients with heart failure, 8.2 for patients with pneumonia, and 7.3 for patients with acute MI. Multivariable adjustments accounted for sex, race, age, and comorbidities.

Study limitations included that the severity of patients' conditions and change post-procedure may not be fully captured by administrative codes, the authors noted. Also, the HFRS was established to identify clusters of healthcare use and may not be beneficial for identifying phenotypic frailty, plus it is unknown to what extent frailty contributes to elevated risks of healthcare use compared to comorbidities alone.

"Further research is needed to understand whether the addition of frailty as measured by the HFRS to current CMS risk-adjustment models affects which hospitals are financially rewarded or penalized under current value-based programs," the researchers concluded.