Association of Frailty With Readmissions and Outcomes After Impella Mechanical Circulatory Support

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-07-01 DOI:10.1016/j.cjco.2025.04.011

Max W. Maffey MBBS , Adrian A. Kuchtaruk BSc , Abdulla A. Damluji MD, PhD , Santiago García MD , Islam Y. Elgendy MD , Pedro Villablanca MD, MSc , Francesco Moroni MD , Martin Denicolai MD , Mamas A. Mamas BMBCh, DPhil , Rodrigo Bagur MD, PhD, FRCPC, DRCPSC, FAHA, FSCAI

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Abstract

Background

Frailty is associated with a greater risk of readmission after cardiovascular procedures. However, the impact of frailty on readmission rates and outcomes after Impella mechanical circulatory support (MCS) remains unknown. We aimed to explore the impact of frailty on readmission outcomes in patients who received Impella MCS.

Methods

Using the National Readmissions Database, patients aged 65 years and older who received Impella MCS between January 2016 and December 2020 were identified. Frailty was determined by the Hospital Frailty Risk Score (HFRS), which stratifies patients into 3 frailty risk categories as low (<5), intermediate (5-15), and high (>15), with intermediate- and high-risk groups defined as frail. The impact of frailty on short-term (within 30 days) and midterm (31-180 days) readmission rates and in-hospital outcomes was assessed.

Results

Of the 16,289 patients identified in the 30-day cohort, 8647 (53.1%) were identified as frail (HFRS ≥5) and 2185 (13.4%) had an unplanned readmission at 30 days. After adjusting for age, sex and comorbidities, frailty status (HFRS ≥5) was associated with a greater risk of 30-day readmission (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.17-1.37), death (OR 2.0, 95% CI 1.22-3.30), major adverse events (OR 1.73, 95% CI 1.29-2.33), length of stay >4 days (OR 1.80, 95% CI 1.44-2.26) and greater hospitalization expenditures (OR 1.44, 95% CI 1.17-1.80) during readmission. Of the 6497 patients identified in the 31-180-day cohort, 3521 (54.2%) were considered frail and 1809 (27.8%) experienced unplanned readmissions. An HFRS ≥5 was associated with a greater risk of readmission (OR 2.10, 95% CI 1.88-2.34), in-hospital death (OR 3.02, 95% CI 1.33-6.86), length of stay >4 days (OR 1.66, 95% CI 1.29-2.14), and greater hospital expenditures (OR 1.36, 95% CI 1.05-1.75) during 31-180-day readmission.

Conclusions

Frailty is common among patients undergoing Impella MCS and is associated with higher rates of readmission and adverse outcomes during readmission.

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虚弱与Impella机械循环支持后再入院和预后的关系

背景：虚弱与心血管手术后再入院的高风险相关。然而，虚弱对Impella机械循环支持（MCS）后再入院率和结果的影响尚不清楚。我们的目的是探讨虚弱对接受Impella MCS患者再入院结果的影响。方法使用国家再入院数据库，识别2016年1月至2020年12月期间接受Impella MCS治疗的65岁及以上患者。虚弱是由医院虚弱风险评分（HFRS）确定的，该评分将患者分为低（<5）、中（>15）和高（>15）三个虚弱风险类别，中高危组定义为虚弱。评估虚弱对短期（30天内）和中期（31-180天）再入院率和住院结局的影响。结果在30天队列中确定的16,289例患者中，8647例（53.1%）被确定为虚弱（HFRS≥5），2185例（13.4%）在30天内出现意外再入院。在调整了年龄、性别和合共病后，虚弱状态（HFRS≥5）与再入院时30天再入院风险较高（优势比[OR] 1.27, 95%可信区间[CI] 1.17-1.37）、死亡（OR 2.0, 95% CI 1.22-3.30）、主要不良事件（OR 1.73, 95% CI 1.29-2.33）、住院时间（OR 1.80, 95% CI 1.44-2.26）和住院费用较高（OR 1.44, 95% CI 1.17-1.80）相关。在31-180天的队列中确定的6497例患者中，3521例（54.2%）被认为虚弱，1809例（27.8%）经历了计划外的再入院。HFRS≥5与再入院31-180天的再入院风险（OR 2.10, 95% CI 1.88-2.34）、院内死亡（OR 3.02, 95% CI 1.33-6.86）、住院时间（OR 1.66, 95% CI 1.29-2.14）和更高的住院费用（OR 1.36, 95% CI 1.05-1.75）相关。结论虚弱在Impella MCS患者中很常见，并且与再入院率和再入院期间的不良结局相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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