The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill Patients
<b>Background:</b> Frailty, with a high prevalence of 40–80% in heart failure, may have a significant bearing on outcomes in patients. This study utilizes the Hospital Frailty Risk Score (HFRS), a validated tool derived from the administrative International Classification of Diseases, 10...
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2025-03-01
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| author | Nahush Bansal Eun Seo Kwak Abdel-Rhman Mohamed Vaishnavi Aradhyula Mohanad Qwaider Alborz Sherafati Ragheb Assaly Ehab Eltahawy |
| author_facet | Nahush Bansal Eun Seo Kwak Abdel-Rhman Mohamed Vaishnavi Aradhyula Mohanad Qwaider Alborz Sherafati Ragheb Assaly Ehab Eltahawy |
| author_sort | Nahush Bansal |
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| description | <b>Background:</b> Frailty, with a high prevalence of 40–80% in heart failure, may have a significant bearing on outcomes in patients. This study utilizes the Hospital Frailty Risk Score (HFRS), a validated tool derived from the administrative International Classification of Diseases, 10th Revision, Clinical Modifications (ICD-10-CM) codes, in investigating the mortality, morbidity, and healthcare resource utilization among heart failure hospitalizations using the Nationwide Inpatient Sample (NIS). <b>Methods:</b> A retrospective analysis of the 2021 NIS database was assessed to identify adult patients hospitalized with heart failure. These patients were stratified by the HFRS into three groups: low frailty (LF: <5), intermediate frailty (IF: 5–15), and high frailty (HF: >15). The outcomes analyzed included inpatient mortality, length of stay (LOS), hospitalization charges, and complications including cardiogenic shock, cardiac arrest, acute kidney injury, and acute respiratory failure. These outcomes were adjusted for age, race, gender, the Charlson comorbidity score, hospital location, region, and teaching status. Multivariate logistic and linear regression analyses were used to assess the association between frailty and clinical outcomes. STATA/MP 18.0 was used for statistical analysis. <b>Results:</b> Among 1,198,988 heart failure admissions, 47.5% patients were in the LF group, whereas the IF and HF groups had 51.1% and 1.4% patients, respectively. Compared to the LF group, the IF group showed a 4-fold higher (adjusted OR = 4.60, <i>p</i> < 0.01), and the HF group had an 11-fold higher (adjusted OR 10.90, <i>p</i> < 0.01) mortality. Frail patients were more likely to have a longer length of stay (4.24 days, 7.18 days, and 12.1 days in the LF, IF, and HF groups) and higher hospitalization charges (USD 49,081, USD 84,472, and USD 129,516 in the LF, IF, and HF groups). Complications were also noticed to be significantly (<i>p</i> < 0.01) higher with increasing frailty from the LF to HF groups. These included cardiogenic shock (1.65% vs. 4.78% vs. 6.82%), cardiac arrest (0.37% vs. 1.61% vs. 3.16%), acute kidney injury (19.2% vs. 54.9% vs. 74.6%), and acute respiratory failure (29.6% vs. 51.2% vs. 60.3%). <b>Conclusions:</b> This study demonstrates the application of HFRS in a national dataset as a predictor of outcome and resource utilization measures in heart failure admissions. Stratifying patients based on HFRS can help in holistic assessment, aid prognostication, and guide targeted interventions in heart failure. |
| format | Article |
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| spelling | doaj-art-0dbedd6115b342b784d6fbd3ac11bd1d2025-08-20T02:11:12ZengMDPI AGBiomedicines2227-90592025-03-0113376010.3390/biomedicines13030760The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill PatientsNahush Bansal0Eun Seo Kwak1Abdel-Rhman Mohamed2Vaishnavi Aradhyula3Mohanad Qwaider4Alborz Sherafati5Ragheb Assaly6Ehab Eltahawy7Department of Medicine, University of Toledo, Toledo, OH 43606, USADepartment of Medicine, University of Toledo, Toledo, OH 43606, USADepartment of Medicine, University of Toledo, Toledo, OH 43606, USADepartment of Medicine, University of Toledo, Toledo, OH 43606, USADepartment of Medicine, University of Toledo, Toledo, OH 43606, USADepartment of Medicine, University of Toledo, Toledo, OH 43606, USADivision of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH 43606, USADivision of Cardiovascular Medicine, University of Toledo, Toledo, OH 43606, USA<b>Background:</b> Frailty, with a high prevalence of 40–80% in heart failure, may have a significant bearing on outcomes in patients. This study utilizes the Hospital Frailty Risk Score (HFRS), a validated tool derived from the administrative International Classification of Diseases, 10th Revision, Clinical Modifications (ICD-10-CM) codes, in investigating the mortality, morbidity, and healthcare resource utilization among heart failure hospitalizations using the Nationwide Inpatient Sample (NIS). <b>Methods:</b> A retrospective analysis of the 2021 NIS database was assessed to identify adult patients hospitalized with heart failure. These patients were stratified by the HFRS into three groups: low frailty (LF: <5), intermediate frailty (IF: 5–15), and high frailty (HF: >15). The outcomes analyzed included inpatient mortality, length of stay (LOS), hospitalization charges, and complications including cardiogenic shock, cardiac arrest, acute kidney injury, and acute respiratory failure. These outcomes were adjusted for age, race, gender, the Charlson comorbidity score, hospital location, region, and teaching status. Multivariate logistic and linear regression analyses were used to assess the association between frailty and clinical outcomes. STATA/MP 18.0 was used for statistical analysis. <b>Results:</b> Among 1,198,988 heart failure admissions, 47.5% patients were in the LF group, whereas the IF and HF groups had 51.1% and 1.4% patients, respectively. Compared to the LF group, the IF group showed a 4-fold higher (adjusted OR = 4.60, <i>p</i> < 0.01), and the HF group had an 11-fold higher (adjusted OR 10.90, <i>p</i> < 0.01) mortality. Frail patients were more likely to have a longer length of stay (4.24 days, 7.18 days, and 12.1 days in the LF, IF, and HF groups) and higher hospitalization charges (USD 49,081, USD 84,472, and USD 129,516 in the LF, IF, and HF groups). Complications were also noticed to be significantly (<i>p</i> < 0.01) higher with increasing frailty from the LF to HF groups. These included cardiogenic shock (1.65% vs. 4.78% vs. 6.82%), cardiac arrest (0.37% vs. 1.61% vs. 3.16%), acute kidney injury (19.2% vs. 54.9% vs. 74.6%), and acute respiratory failure (29.6% vs. 51.2% vs. 60.3%). <b>Conclusions:</b> This study demonstrates the application of HFRS in a national dataset as a predictor of outcome and resource utilization measures in heart failure admissions. Stratifying patients based on HFRS can help in holistic assessment, aid prognostication, and guide targeted interventions in heart failure.https://www.mdpi.com/2227-9059/13/3/760frailtyheart failurehospital frailty risk score (HFRS)in-hospital mortalityrisk stratificationnational inpatient sample (NIS) |
| spellingShingle | Nahush Bansal Eun Seo Kwak Abdel-Rhman Mohamed Vaishnavi Aradhyula Mohanad Qwaider Alborz Sherafati Ragheb Assaly Ehab Eltahawy The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill Patients Biomedicines frailty heart failure hospital frailty risk score (HFRS) in-hospital mortality risk stratification national inpatient sample (NIS) |
| title | The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill Patients |
| title_full | The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill Patients |
| title_fullStr | The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill Patients |
| title_full_unstemmed | The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill Patients |
| title_short | The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill Patients |
| title_sort | hospital frailty risk score as a predictor of mortality complications and resource utilization in heart failure implications for managing critically ill patients |
| topic | frailty heart failure hospital frailty risk score (HFRS) in-hospital mortality risk stratification national inpatient sample (NIS) |
| url | https://www.mdpi.com/2227-9059/13/3/760 |
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