Frailty and associated outcomes and resource utilization following in-hospital cardiac arrest

Shannon M Fernando; Daniel I McIsaac; Bram Rochwerg; Deborah J Cook; Sean M Bagshaw; John Muscedere; Laveena Munshi; Jerry P Nolan; Jeffrey J Perry; James Downar; Chintan Dave; Peter M Reardon; Peter Tanuseputro; Kwadwo Kyeremanteng

doi:10.1016/j.resuscitation.2019.11.011

Frailty and associated outcomes and resource utilization following in-hospital cardiac arrest

Resuscitation. 2020 Jan 1:146:138-144. doi: 10.1016/j.resuscitation.2019.11.011. Epub 2019 Nov 27.

Authors

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. Electronic address: sfernando@qmed.ca.
² Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁵ Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada.
⁷ Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
⁸ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyere Research Institute, Ottawa, ON, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
¹² School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyere Research Institute, Ottawa, ON, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹³ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada.

PMID: 31785373
DOI: 10.1016/j.resuscitation.2019.11.011

Abstract

Background: In-hospital cardiac arrest (IHCA) is common and associated with high mortality. Frailty is increasingly recognized as a predictor of worse prognosis among critically ill patients, but its association with outcomes and resource utilization following IHCA is unknown.

Methods: We performed a retrospective analysis (2013-2016) of a prospectively collected registry from two hospitals of consecutive hospitalized adult patients with IHCA occurring on the hospital wards. We defined frailty using the Clinical Frailty Scale (CFS) score ≥5. CFS scores were based on validated medical review criteria. The primary outcome is hospital mortality. Secondary outcomes include return of spontaneous circulation (ROSC), discharge to long-term care, and hospital costs. We used multivariable logistic regression to adjust for known confounders.

Results: We included 477 patients, and 124 (26.0%) had frailty. Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 2.91 [95% confidence interval [CI]: 2.37-3.48) and discharge to long-term care (aOR 1.94 [95% CI: 1.57-2.32]). Compared with patients without frailty, patients with frailty had decreased odds of ROSC following IHCA (aOR 0.63 [95% CI: 0.41-0.93]). No difference in mean total costs was demonstrated between patients with and without frailty ($50,799 vs. $45,849). Frail patients did have higher cost-per-survivor ($947,546 vs. $161,550).

Conclusions: Frail individuals who experience an IHCA are more likely to die in hospital or be discharged to long-term care, and less likely to achieve ROSC in comparison with individuals who are not frail. The hospital costs per-survivor of IHCA are increased when frailty is present.

Keywords: Frailty; Hospital costs; In-hospital cardiac arrest; Intensive care unit.

MeSH terms

Aged
Canada / epidemiology
Cardiopulmonary Resuscitation* / methods
Cardiopulmonary Resuscitation* / statistics & numerical data
Costs and Cost Analysis
Critical Care Outcomes
Critical Illness* / economics
Critical Illness* / epidemiology
Critical Illness* / therapy
Female
Frailty* / complications
Frailty* / diagnosis
Frailty* / mortality
Heart Arrest* / complications
Heart Arrest* / mortality
Heart Arrest* / therapy
Hospital Mortality
Hospitalization / economics
Hospitalization / statistics & numerical data
Humans
Long-Term Care / economics
Long-Term Care / statistics & numerical data
Male
Middle Aged
Prognosis
Return of Spontaneous Circulation
Risk Factors