The Use of Novel Frailty Index As A Predictor of Clinical Outcomes in Patients Hospitalized with Cardiogenic Shock

Background Cardiogenic shock (CS) is a state of low cardiac output that causes tissue hypoperfusion and end-organ damage resulting in hemodynamic instability. Acute decompensated heart failure (ADHF) is one of the leading causes of CS and mortality remains high despite medical advances. Hemodynamic monitoring, laboratory values and risk scores have been developed to identify of those at highest risk for deterioration. While a patient's frailty has been shown to impact hospitalization course and overall mortality, little is known on the impact of frailty on cardiogenic shock. This study aims to assess a novel, health record-based Electronic Frailty Index (eFI) to predict outcomes of patients with CS. Methods An observational, retrospective cohort study in patients admitted with ADHF. Data was collected using electronic medical record. Inclusion criteria were patients ≥ 65 years of age admitted with ADHF requiring inotropes (milrinone and dobutamine) from January 2018 - December 2019 at Atrium Health Wake Forest Baptist Medical Center. Patients were categorized by their frailty into two groups: Frail (eFI > 0.2) and Not Frail (eFI ≤ 0.2). SCAI stage and GWTG-HR risk scores were determined. Analysis was performed by analysis of variance (ANOVA) and chi-squared on continuous and categorical variables, respectively. Primary outcome was in-hospital mortality. Secondary outcome included days on inotropic therapy, hospital length of stay (LOS), 30-day and 6-month readmission and mortality. Results A total of 146 patients were included in the study. Mean age and stand deviation (SD) of the cohort was 71.6 years (8.5) comprised of 26.7% female and 73.3% non-Hispanic whites. Of the 146 patient's, 78 (53.4%) were classified as Frail based on their eFI and 68 (46.6%) were classified as Not Frail. Baseline charateristics are shown in Table 1. There was no significant difference in the primary or secondary outcomes, shown in Figure 1. Conclusions An increasing burden of frailty, as assessed by the eFI, did not predict in-hospital mortality, LOS, 30-day or 6-month mortality and readmission in patient with CS, regardless of SCAI stage or GWTG score. These results support that a patient's frailty should not impede their treatment plan due to fear of adverse outcomes. Cardiogenic shock (CS) is a state of low cardiac output that causes tissue hypoperfusion and end-organ damage resulting in hemodynamic instability. Acute decompensated heart failure (ADHF) is one of the leading causes of CS and mortality remains high despite medical advances. Hemodynamic monitoring, laboratory values and risk scores have been developed to identify of those at highest risk for deterioration. While a patient's frailty has been shown to impact hospitalization course and overall mortality, little is known on the impact of frailty on cardiogenic shock. This study aims to assess a novel, health record-based Electronic Frailty Index (eFI) to predict outcomes of patients with CS. An observational, retrospective cohort study in patients admitted with ADHF. Data was collected using electronic medical record. Inclusion criteria were patients ≥ 65 years of age admitted with ADHF requiring inotropes (milrinone and dobutamine) from January 2018 - December 2019 at Atrium Health Wake Forest Baptist Medical Center. Patients were categorized by their frailty into two groups: Frail (eFI > 0.2) and Not Frail (eFI ≤ 0.2). SCAI stage and GWTG-HR risk scores were determined. Analysis was performed by analysis of variance (ANOVA) and chi-squared on continuous and categorical variables, respectively. Primary outcome was in-hospital mortality. Secondary outcome included days on inotropic therapy, hospital length of stay (LOS), 30-day and 6-month readmission and mortality. A total of 146 patients were included in the study. Mean age and stand deviation (SD) of the cohort was 71.6 years (8.5) comprised of 26.7% female and 73.3% non-Hispanic whites. Of the 146 patient's, 78 (53.4%) were classified as Frail based on their eFI and 68 (46.6%) were classified as Not Frail. Baseline charateristics are shown in Table 1. There was no significant difference in the primary or secondary outcomes, shown in Figure 1. An increasing burden of frailty, as assessed by the eFI, did not predict in-hospital mortality, LOS, 30-day or 6-month mortality and readmission in patient with CS, regardless of SCAI stage or GWTG score. These results support that a patient's frailty should not impede their treatment plan due to fear of adverse outcomes.