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

Sokhal, Balamrit Singh; Matetić, Andrija; Abhishek, Abhishek; Banerjee, Amitava; Partington, Richard; Roddy, Edward; Rashid, Muhammad; ... Mamas, Mamas Andreas; + view all (2023) Impact of Frailty on Emergency Department Encounters for Cardiovascular Disease: A Retrospective Cohort Study. The American Journal of Cardiology , 206 pp. 210-218. 10.1016/j.amjcard.2023.08.138. Green open access

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Abstract

Data are limited on whether the causes of emergency department (ED) encounters for cardiovascular diseases (CVDs) and associated clinical outcomes vary by frailty status. Using the United States Nationwide ED Sample, selected CVD encounters (acute myocardial infarction [AMI], ischemic stroke, atrial fibrillation [AF], heart failure [HF], pulmonary embolism, cardiac arrest, and hemorrhagic stroke) were stratified by hospital frailty risk score (HFRS). Logistic regression was used to determine the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of ED mortality among the different frailty groups. A total of 8,577,028 selected CVD ED encounters were included. A total of 5,120,843 (59.7%) had a low HFRS (<5), 3,041,699 (35.5%) had an intermediate HFRS (5 to 15), and 414,485 (4.8%) had a high HFRS (>15). Ischemic stroke was the most common reason for the encounter in the high HFRS group (66.9%), followed by hemorrhagic stroke (11.7%) and AMI (7.2%). For the low HFRS group, AF was the most common reason for the encounter (30.2%), followed by AMI (23.6%) and HF (16.8%). Compared with the low-risk group, high-risk patients had a decreased ED mortality and an increased overall mortality across most CVD encounters (p <0.001). The strongest association with overall mortality was observed among patients with a high HFRS admitted for AF (aOR 27.14, 95% CI 25.03 to 29.43) and HF (aOR 13.71, 95% CI 12.95 to 14.51) compared with their low-risk counterparts. In conclusion, patients presenting to the ED with acute CVD have a significant frailty burden, with different patterns of CVD according to frailty status. Frailty is associated with an increased all-cause mortality in patients for most CVD encounters.

Type: Article
Title: Impact of Frailty on Emergency Department Encounters for Cardiovascular Disease: A Retrospective Cohort Study
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.amjcard.2023.08.138
Publisher version: https://doi.org/10.1016/j.amjcard.2023.08.138
Language: English
Additional information: Copyright © 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Cardiovascular disease; emergency department; frailty; mortality
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10177259
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