Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia
Background The impact of medical record‐based frailty assessment on clinical outcomes in patients undergoing revascularization for critical limb‐threatening ischemia (CLTI) is unknown. Methods and Results This study included patients with CLTI aged ≥18 years from the nationwide readmissions database...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030294 |
| _version_ | 1797689839981690880 |
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| author | Monil Majmundar Kunal N. Patel Rajkumar Doshi Harsh Mehta Mohinder R. Vindhyal Kirk A Hance Adam Ali Kamal Gupta |
| author_facet | Monil Majmundar Kunal N. Patel Rajkumar Doshi Harsh Mehta Mohinder R. Vindhyal Kirk A Hance Adam Ali Kamal Gupta |
| author_sort | Monil Majmundar |
| collection | DOAJ |
| description | Background The impact of medical record‐based frailty assessment on clinical outcomes in patients undergoing revascularization for critical limb‐threatening ischemia (CLTI) is unknown. Methods and Results This study included patients with CLTI aged ≥18 years from the nationwide readmissions database 2016 to 2018 who underwent endovascular revascularization (ER) or surgical revascularization (SR). The hospital frailty risk score, a previously validated International Classification of Diseases, Tenth Edition, Clinical Modification (ICD‐10‐CM) claims‐based score, was used to categorize patients into low‐ (<5), intermediate‐ (5–15), and high‐risk (>15) frailty categories. Primary outcomes were in‐hospital mortality and major amputation at 6 months. A total of 64 338 patients were identified who underwent ER (82.3%) or SR (17.7%) for CLTI. The mean (SD) age of the cohort was 69.3 (11.8) years, and 63% of patients were male. This study found a nonlinear association between hospital frailty risk score and in‐hospital mortality and 6‐month major amputation. In both ER and SR cohorts, the intermediate‐ and high‐risk groups were associated with a significantly higher risk of in‐hospital mortality (high‐risk group: ER: odds ratio [OR], 7.2 [95% CI, 4.4–11.6], P<0.001; SR: OR, 28.6 [95% CI, 3.4–237.6], P=0.002) and major amputation at 6 months (high‐risk group: ER: hazard ratio [HR], 1.6 [95% CI, 1.5–1.7], P<0.001; SR: HR, 1.7 [95% CI, 1.4–2.2], P<0.001) compared with the low‐risk group. Conclusions The hospital frailty risk score, generated from the medical record, can identify frailty and predict in‐hospital mortality and 6‐month major amputation in patients undergoing ER or SR for CLTI. Further studies are needed to assess if this score can be incorporated into clinical decision‐making in patients undergoing revascularization for CLTI. |
| first_indexed | 2024-03-12T01:51:43Z |
| format | Article |
| id | doaj.art-c7c16af5f92c46cd9b00e06343de9746 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-12T01:51:43Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c7c16af5f92c46cd9b00e06343de97462023-09-08T12:39:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-09-01121710.1161/JAHA.123.030294Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening IschemiaMonil Majmundar0Kunal N. Patel1Rajkumar Doshi2Harsh Mehta3Mohinder R. Vindhyal4Kirk A Hance5Adam Ali6Kamal Gupta7Department of Cardiovascular Medicine University of Kansas Medical Center Kansas City KS USADepartment of Cardiovascular Medicine West Virginia University Morgantown WV USADepartment of Cardiology St. Joseph’s University Medical Center Paterson NJ USADepartment of Cardiovascular Medicine University of Kansas Medical Center Kansas City KS USADepartment of Cardiovascular Medicine University of Kansas Medical Center Kansas City KS USADepartment of Surgery, Division of Vascular Surgery University of Kansas Medical Center KS Kansas City USADepartment of Radiology University of Kansas Medical Center Kansas City KS USADepartment of Cardiovascular Medicine University of Kansas Medical Center Kansas City KS USABackground The impact of medical record‐based frailty assessment on clinical outcomes in patients undergoing revascularization for critical limb‐threatening ischemia (CLTI) is unknown. Methods and Results This study included patients with CLTI aged ≥18 years from the nationwide readmissions database 2016 to 2018 who underwent endovascular revascularization (ER) or surgical revascularization (SR). The hospital frailty risk score, a previously validated International Classification of Diseases, Tenth Edition, Clinical Modification (ICD‐10‐CM) claims‐based score, was used to categorize patients into low‐ (<5), intermediate‐ (5–15), and high‐risk (>15) frailty categories. Primary outcomes were in‐hospital mortality and major amputation at 6 months. A total of 64 338 patients were identified who underwent ER (82.3%) or SR (17.7%) for CLTI. The mean (SD) age of the cohort was 69.3 (11.8) years, and 63% of patients were male. This study found a nonlinear association between hospital frailty risk score and in‐hospital mortality and 6‐month major amputation. In both ER and SR cohorts, the intermediate‐ and high‐risk groups were associated with a significantly higher risk of in‐hospital mortality (high‐risk group: ER: odds ratio [OR], 7.2 [95% CI, 4.4–11.6], P<0.001; SR: OR, 28.6 [95% CI, 3.4–237.6], P=0.002) and major amputation at 6 months (high‐risk group: ER: hazard ratio [HR], 1.6 [95% CI, 1.5–1.7], P<0.001; SR: HR, 1.7 [95% CI, 1.4–2.2], P<0.001) compared with the low‐risk group. Conclusions The hospital frailty risk score, generated from the medical record, can identify frailty and predict in‐hospital mortality and 6‐month major amputation in patients undergoing ER or SR for CLTI. Further studies are needed to assess if this score can be incorporated into clinical decision‐making in patients undergoing revascularization for CLTI.https://www.ahajournals.org/doi/10.1161/JAHA.123.030294amputationchronic limb‐threatening ischemiaendovascular revascularizationfrail elderlyfrailtymortality |
| spellingShingle | Monil Majmundar Kunal N. Patel Rajkumar Doshi Harsh Mehta Mohinder R. Vindhyal Kirk A Hance Adam Ali Kamal Gupta Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease amputation chronic limb‐threatening ischemia endovascular revascularization frail elderly frailty mortality |
| title | Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia |
| title_full | Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia |
| title_fullStr | Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia |
| title_full_unstemmed | Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia |
| title_short | Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb–Threatening Ischemia |
| title_sort | prognostic value of hospital frailty risk score and clinical outcomes in patients undergoing revascularization for critical limb threatening ischemia |
| topic | amputation chronic limb‐threatening ischemia endovascular revascularization frail elderly frailty mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030294 |
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