Systematic Review of the Association of the Hospital Frailty Risk Score with Mortality in Patients with Cerebrovascular and Cardiovascular Disease

Article ID: e290224227533 Pages: 18

  • * (Excluding Mailing and Handling)

Abstract

Background: There is limited systematic data on the association between the Hospital Frailty Risk Score (HFRS) and characteristics and mortality in patients with cerebrovascular and cardiovascular disease (CVD). This systematic review aimed to summarise the use of the HFRS in describing the prevalence of frailty in patients with CVD, the clinical characteristics of patients with CVD, and the association between frailty on the likelihood of mortality in patients with CVD.

Methods: A systematic literature search for observational studies using terms related to CVD, cerebrovascular disease, and the HFRS was conducted using 6 databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were appraised using the Newcastle-Ottawa Scale (NOS).

Results: Seventeen observational studies were included, all rated ‘good’ quality according to the NOS. One study investigated 5 different CVD cohorts (atrial fibrillation (AF), heart failure (HF), hypotension, hypertension, and chronic ischemic heart disease), 1 study investigated 2 different CVD cohorts (AF and acute myocardial infarction (AMI)), 6 studies investigated HF, 3 studies investigated AMI, 4 studies investigated stroke, 1 study investigated AF, and 1 study investigated cardiac arrest. Increasing frailty risk category was associated with increased age, female sex, and non-white racial group across all CVD. Increasing frailty risk category is also associated with increased length of hospital stay, total costs, and increased odds of 30-day all-cause mortality across all CVD.

Conclusions: The HFRS is an efficient and effective tool for stratifying frailty in patients with CVD and predicting adverse health outcomes.

Graphical Abstract

[1]
Xue QL. The frailty syndrome: Definition and natural history. Clin Geriatr Med 2011; 27(1): 1-15.
[http://dx.doi.org/10.1016/j.cger.2010.08.009] [PMID: 21093718]
[2]
Ramsay SE, Arianayagam DS, Whincup PH, et al. Cardiovascular risk profile and frailty in a population-based study of older British men. Heart 2015; 101(8): 616-22.
[http://dx.doi.org/10.1136/heartjnl-2014-306472] [PMID: 25480883]
[3]
Talha KM, Pandey A, Fudim M, Butler J, Anker SD, Khan MS. Frailty and heart failure: State‐of‐the‐art review. J Cachexia Sarcopenia Muscle 2023; 14(5): 1959-72.
[http://dx.doi.org/10.1002/jcsm.13306] [PMID: 37586848]
[4]
Ko D, Bostrom JA, Qazi S, Kramer DB, Kim DH, Orkaby AR. Frailty and cardiovascular mortality: A narrative review. Curr Cardiol Rep 2023; 25(4): 249-59.
[http://dx.doi.org/10.1007/s11886-023-01847-0] [PMID: 36795307]
[5]
United States Census Bureau website.. Population Estimates. United States Census Bureau. 2008. Available from: https://www.census.gov/ (Retrieved September 1, 2023).
[6]
Marinus N, Vigorito C, Giallauria F, et al. Frailty is highly prevalent in specific cardiovascular diseases and females, but significantly worsens prognosis in all affected patients: A systematic review. Ageing Res Rev 2021; 66: 101233.
[http://dx.doi.org/10.1016/j.arr.2020.101233] [PMID: 33333322]
[7]
Ng Cheong Chung KJ, Wilkinson C, Veerasamy M, Kunadian V. Frailty scores and their utility in older patients with cardiovascular disease. Interv Cardiol 2021; 16: e05.
[http://dx.doi.org/10.15420/icr.2020.18] [PMID: 33897831]
[8]
Newman AB, Gottdiener JS, McBurnie MA, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci 2001; 56(3): M158-66.
[http://dx.doi.org/10.1093/gerona/56.3.M158] [PMID: 11253157]
[9]
Stewart R. Cardiovascular disease and frailty: What are the mechanistic links? Clin Chem 2019; 65(1): 80-6.
[http://dx.doi.org/10.1373/clinchem.2018.287318] [PMID: 30504259]
[10]
Clegg A, Bates C, Young J, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 2016; 45(3): 353-60.
[http://dx.doi.org/10.1093/ageing/afw039] [PMID: 26944937]
[11]
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173(5): 489-95.
[http://dx.doi.org/10.1503/cmaj.050051] [PMID: 16129869]
[12]
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59(3): M255-63.
[http://dx.doi.org/10.1093/gerona/59.3.M255] [PMID: 15031310]
[13]
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): M146-57.
[http://dx.doi.org/10.1093/gerona/56.3.M146] [PMID: 11253156]
[14]
Gilbert T, Neuburger J, Kraindler J, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: An observational study. Lancet 2018; 391(10132): 1775-82.
[http://dx.doi.org/10.1016/S0140-6736(18)30668-8] [PMID: 29706364]
[15]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Syst Rev 2021; 10(1): 89.
[http://dx.doi.org/10.1186/s13643-021-01626-4] [PMID: 33781348]
[16]
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25(9): 603-5.
[http://dx.doi.org/10.1007/s10654-010-9491-z] [PMID: 20652370]
[17]
Pascual-González Y, López-Sánchez M, Dorca J, Santos S. Defining the role of neutrophil-to-lymphocyte ratio in COPD: A systematic literature review. Int J Chron Obstruct Pulmon Dis 2018; 13: 3651-62.
[http://dx.doi.org/10.2147/COPD.S178068] [PMID: 30464448]
[18]
Campbell M, McKenzie JE, Sowden A, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. BMJ 2020; 368: l6890.
[http://dx.doi.org/10.1136/bmj.l6890] [PMID: 31948937]
[19]
Higgins JP, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons 2019.
[http://dx.doi.org/10.1002/9781119536604]
[20]
Nghiem S, Afoakwah C, Scuffham P, Byrnes J. Hospital frailty risk score and adverse health outcomes: Evidence from longitudinal record linkage cardiac data. Age Ageing 2021; 50(5): 1778-84.
[http://dx.doi.org/10.1093/ageing/afab073] [PMID: 33989395]
[21]
Kundi H, Wadhera RK, Strom JB, et al. Association of frailty with 30-day outcomes for acute myocardial infarction, heart failure, and pneumonia among elderly adults. JAMA Cardiol 2019; 4(11): 1084-91.
[http://dx.doi.org/10.1001/jamacardio.2019.3511] [PMID: 31553402]
[22]
Kwok CS, Zieroth S, Van Spall HGC, et al. The hospital frailty risk score and its association with in-hospital mortality, cost, length of stay and discharge location in patients with heart failure short running title: Frailty and outcomes in heart failure. Int J Cardiol 2020; 300: 184-90.
[http://dx.doi.org/10.1016/j.ijcard.2019.09.064] [PMID: 31699454]
[23]
McAlister FA, Savu A, Ezekowitz JA, Armstrong PW, Kaul P. The hospital frailty risk score in patients with heart failure is strongly associated with outcomes but less so with pharmacotherapy. J Intern Med 2020; 287(3): 322-32.
[http://dx.doi.org/10.1111/joim.13002] [PMID: 31661589]
[24]
Sharma Y, Horwood C, Hakendorf P, Thompson C. Trends in frailty and use of evidence-based pharmacotherapy for heart failure in australian hospitalised patients: An observational study. J Clin Med 2021; 10(24): 5780.
[http://dx.doi.org/10.3390/jcm10245780] [PMID: 34945076]
[25]
Sharma Y, Horwood C, Hakendorf P, Shahi R, Thompson C. External validation of the hospital frailty-risk score in predicting clinical outcomes in older heart-failure patients in Australia. J Clin Med 2022; 11(8): 2193.
[http://dx.doi.org/10.3390/jcm11082193] [PMID: 35456288]
[26]
Sharma Y, Horwood C, Hakendorf P, Thompson C. Benefits of heart failure specific pharmacotherapy in frail hospitalised heart failure patients: An observational study. Heart Lung Circ 2022; 31: S72.
[http://dx.doi.org/10.1016/j.hlc.2022.06.065]
[27]
Sharma Y, Horwood C, Hakendorf P, Thompson C. Characteristics and outcomes of patients with heart failure discharged from different speciality units in Australia: An observational study. QJM 2022; 115(11): 727-34.
[http://dx.doi.org/10.1093/qjmed/hcac051]
[28]
Kwok CS, Lundberg G, Al-Faleh H, et al. Relation of frailty to outcomes in patients with acute coronary syndromes. Am J Cardiol 2019; 124(7): 1002-11.
[http://dx.doi.org/10.1016/j.amjcard.2019.07.003] [PMID: 31421814]
[29]
Lopez D, Preen DB, Etherton-Beer C, Sanfilippo FM. Frailty, and not medicines with anticholinergic or sedative effects, predicts adverse outcomes in octogenarians admitted for myocardial infarction: Population‐level study. Australas J Ageing 2021; 40(2): e155-62.
[http://dx.doi.org/10.1111/ajag.12891] [PMID: 33615643]
[30]
Borovac JA, Mohamed MO, Kontopantelis E, et al. Frailty among patients with acute ST-elevation myocardial infarction in the United States: The impact of the primary percutaneous coronary intervention on in-hospital outcomes. J Invasive Cardiol 2022; 34(1): E55-64.
[PMID: 34982727]
[31]
Zhang W, Anderson CS, Kilkenny MF, et al. Hospital admissions prior to primary intracerebral haemorrhage and relevant factors associated with survival. J Stroke Cerebrovasc Dis 2020; 29(9): 105026.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105026] [PMID: 32807441]
[32]
Kilkenny MF, Phan HT, Lindley RI, et al. Utility of the hospital frailty risk score derived from administrative data and the association with stroke outcomes. Stroke 2021; 52(9): 2874-81.
[http://dx.doi.org/10.1161/STROKEAHA.120.033648] [PMID: 34134509]
[33]
Pinho J, Küppers C, Nikoubashman O, et al. Frailty is an outcome predictor in patients with acute ischemic stroke receiving endovascular treatment. Age Ageing 2021; 50(5): 1785-91.
[http://dx.doi.org/10.1093/ageing/afab092] [PMID: 34087930]
[34]
Schnieder M, Bähr M, Kirsch M, et al. Analysis of frailty in geriatric patients as a prognostic factor in endovascular treated patients with large vessel occlusion strokes. J Clin Med 2021; 10(10): 2171.
[http://dx.doi.org/10.3390/jcm10102171] [PMID: 34069797]
[35]
Wang A, Ferro EG, Song Y, et al. Frailty in patients undergoing percutaneous left atrial appendage closure. Heart Rhythm 2022; 19(5): 814-21.
[http://dx.doi.org/10.1016/j.hrthm.2022.01.007] [PMID: 35031495]
[36]
Yang PS, Sung JH, Jang E, et al. Application of the simple atrial fibrillation better care pathway for integrated care management in frail patients with atrial fibrillation: A nationwide cohort study. J Arrhythm 2020; 36(4): 668-77.
[http://dx.doi.org/10.1002/joa3.12364] [PMID: 32782638]
[37]
Smith RJ, Reid DA, Santamaria JD. Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest. Intern Med J 2019; 49(8): 978-85.
[http://dx.doi.org/10.1111/imj.14159] [PMID: 30411470]
[38]
Walston J, Buta B, Xue QL. Frailty screening and interventions. Clin Geriatr Med 2018; 34(1): 25-38.
[http://dx.doi.org/10.1016/j.cger.2017.09.004] [PMID: 29129215]
[39]
Sharma A, Harrington RA, McClellan MB, et al. Using digital health technology to better generate evidence and deliver evidence-based care. J Am Coll Cardiol 2018; 71(23): 2680-90.
[http://dx.doi.org/10.1016/j.jacc.2018.03.523] [PMID: 29880129]
[40]
Hollinghurst J, Housley G, Watkins A, Clegg A, Gilbert T, Conroy SP. A comparison of two national frailty scoring systems. Age Ageing 2021; 50(4): 1208-14.
[http://dx.doi.org/10.1093/ageing/afaa252] [PMID: 33252680]
[41]
Veronese N, Cereda E, Stubbs B, et al. Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis. Ageing Res Rev 2017; 35: 63-73.
[http://dx.doi.org/10.1016/j.arr.2017.01.003] [PMID: 28143778]
[42]
Ofori-Asenso R, Chin KL, Mazidi M, et al. Global incidence of frailty and prefrailty among community-dwelling older adults. JAMA Netw Open 2019; 2(8): e198398.
[http://dx.doi.org/10.1001/jamanetworkopen.2019.8398] [PMID: 31373653]
[43]
Afilalo J, Karunananthan S, Eisenberg MJ, Alexander KP, Bergman H. Role of frailty in patients with cardiovascular disease. Am J Cardiol 2009; 103(11): 1616-21.
[http://dx.doi.org/10.1016/j.amjcard.2009.01.375] [PMID: 19463525]
[44]
Gunnarsdottir GM, Helgadottir S, Einarsson SG, et al. Validation of the hospital frailty risk score in older surgical patients: A population‐based retrospective cohort study. Acta Anaesthesiol Scand 2021; 65(8): 1033-42.
[http://dx.doi.org/10.1111/aas.13837] [PMID: 33948935]
[45]
Bandeen-Roche K, Xue QL, Ferrucci L, et al. Phenotype of frailty: Characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci 2006; 61(3): 262-6.
[http://dx.doi.org/10.1093/gerona/61.3.262] [PMID: 16567375]
[46]
Ferrucci L, Fabbri E. Inflammageing: Chronic inflammation in ageing, cardiovascular disease, and frailty. Nat Rev Cardiol 2018; 15(9): 505-22.
[http://dx.doi.org/10.1038/s41569-018-0064-2] [PMID: 30065258]
[47]
Afilalo J, Alexander KP, Mack MJ, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014; 63(8): 747-62.
[http://dx.doi.org/10.1016/j.jacc.2013.09.070] [PMID: 24291279]
[48]
Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial fibrillation. Circ Res 2017; 120(9): 1501-17.
[http://dx.doi.org/10.1161/CIRCRESAHA.117.309732] [PMID: 28450367]
[49]
Orhan AL, Cinar T, Hayiroglu MI, et al. Atrial fibrillation as a preoperative risk factor predicts long-term mortality in elderly patients without heart failure and undergoing hip fracture surgery. Rev Assoc Med Bras 2021; 67(11): 1633-8.
[http://dx.doi.org/10.1590/1806-9282.20210686]
[50]
Hayıroğlu Mİ, Çınar T, Çinier G, et al. Cardiac variables associated with atrial fibrillation occurrence and mortality in octogenarians implanted with dual chamber permanent pacemakers. Aging Clin Exp Res 2022; 34(10): 2533-9.
[http://dx.doi.org/10.1007/s40520-022-02194-w] [PMID: 35834163]
[51]
Triposkiadis F, Xanthopoulos A, Butler J. Cardiovascular aging and heart failure. J Am Coll Cardiol 2019; 74(6): 804-13.
[http://dx.doi.org/10.1016/j.jacc.2019.06.053] [PMID: 31395131]
[52]
Li Z, Wijeysundera HC, Bagur R, et al. Performance of administrative database frailty instruments in predicting clinical outcomes and cost for patients undergoing transcatheter aortic valve implantation: A historical cohort study. Can J Anaesth 2022.
[PMID: 36577891]
[53]
Mak JKL, Eriksdotter M, Annetorp M, et al. Two years with COVID-19: The electronic frailty index identifies high-risk patients in the stockholm gerocovid study. Gerontology 2022; 1-10.
[PMID: 36450240]
[54]
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: A systematic review. J Am Geriatr Soc 2012; 60(8): 1487-92.
[http://dx.doi.org/10.1111/j.1532-5415.2012.04054.x] [PMID: 22881367]
[55]
O’Caoimh R, Sezgin D, O’Donovan MR, et al. Prevalence of frailty in 62 countries across the world: A systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50(1): 96-104.
[http://dx.doi.org/10.1093/ageing/afaa219] [PMID: 33068107]
[56]
Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: A systematic review and meta-analysis. BMJ Open 2018; 8(3): e018195.
[http://dx.doi.org/10.1136/bmjopen-2017-018195] [PMID: 29496895]
[57]
Waters DL, van Kan GA, Cesari M, Vidal K, Rolland Y, Vellas B. Gender specific associations between frailty and body composition. J Frailty Aging 2012; 1(1): 18-23.
[PMID: 27092933]
[58]
Hubbard RE. Sex differences in frailty. Interdiscip Top Gerontol Geriatr 2015; 41: 41-53.
[http://dx.doi.org/10.1159/000381161] [PMID: 26301978]
[59]
Hirsch C, Anderson M, Newman A, et al. The association of race with frailty: The cardiovascular health study. Ann Epidemiol 2006; 16(7): 545-53.
[http://dx.doi.org/10.1016/j.annepidem.2005.10.003] [PMID: 16388967]
[60]
Usher T, Buta B, Thorpe RJ Jr, et al. Dissecting the racial/ethnic disparity in frailty in a nationally representative cohort study with respect to health, income, and measurement. J Gerontol A Biol Sci Med Sci 2021; 76(1): 69-76.
[http://dx.doi.org/10.1093/gerona/glaa061] [PMID: 32147727]
[61]
Murad K, Kitzman DW. Frailty and multiple comorbidities in the elderly patient with heart failure: Implications for management. Heart Fail Rev 2012; 17(4-5): 581-8.
[http://dx.doi.org/10.1007/s10741-011-9258-y] [PMID: 21626426]
[62]
Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019. J Am Coll Cardiol 2020; 76(25): 2982-3021.
[http://dx.doi.org/10.1016/j.jacc.2020.11.010] [PMID: 33309175]
[63]
Kataria S, Ravindran V. Electronic health records: A critical appraisal of strengths and limitations. J R Coll Phys Edinb 2020; 50(3): 262-8.
[http://dx.doi.org/10.4997/jrcpe.2020.309] [PMID: 32936099]
[64]
Dahlöf B. Cardiovascular disease risk factors: Epidemiology and risk assessment. Am J Cardiol 2010; 105(1): 3A-9A.
[http://dx.doi.org/10.1016/j.amjcard.2009.10.007] [PMID: 20102968]
[65]
Granziera S, Cohen AT, Nante G, Manzato E, Sergi G. Thromboembolic prevention in frail elderly patients with atrial fibrillation: A practical algorithm. J Am Med Dir Assoc 2015; 16(5): 358-64.
[http://dx.doi.org/10.1016/j.jamda.2014.12.008] [PMID: 25680239]
[66]
Hayıroğlu MI. Telemedicine: Current concepts and future perceptions. Anatol J Cardiol 2019; 22: 21-2.
[PMID: 31670712]
[67]
Nagatomi Y, Ide T, Higuchi T, et al. Home‐based cardiac rehabilitation using information and communication technology for heart failure patients with frailty. ESC Heart Fail 2022; 9(4): 2407-18.
[http://dx.doi.org/10.1002/ehf2.13934] [PMID: 35534907]