Association between frailty, use of advanced therapies, in-hospital outcomes, and 30-day readmission in elderly patients admitted with acute pulmonary embolism.

Background: Frailty increases vulnerability to morbidity and mortality among elderly individuals, particularly those with acute pulmonary embolism (PE). Elderly patients, especially frail ones, remain underrepresented in studies evaluating advanced PE therapies, creating uncertainty regarding therapy utilization and outcomes.

Methods: Using the National Readmission Database (NRD), elderly patients (>75 years) admitted with acute PE between 2016 and 2020 were identified via ICD-10 codes. Patients were stratified based on the Hospital Frailty Risk Score (HFRS >5 defined frailty) and clinical presentation (high-risk vs. non-high-risk features). Advanced therapies analyzed included systemic thrombolysis (ST), catheter-directed thrombolysis (CDT), catheter-directed embolectomy (CDE), and surgical embolectomy (SE). Logistic regression adjusted for demographics and comorbidities compared in-hospital outcomes between frail and non-frail patients.

Results: A total of 233,091 patients were included; 53.0 % without and 79.9 % with high-risk features were frail. Advanced therapy utilization did not differ significantly between frail and non-frail patients within high-risk PE. Frail patients experienced higher in-hospital mortality in both non-high-risk (7.2 % vs. 1.8 %, adjusted OR [aOR]: 2.3, 95 % confidence interval [CI]: 2.2-2.6, p < 0.001) and high-risk groups (36.2 % vs. 30.2 %, aOR: 1.2, 95 % CI: 1.0-1.3, p = 0.02). Frailty was associated with increased intracranial hemorrhage (aOR: 3.9, 95 % CI: 3.3-4.7, p < 0.001), gastrointestinal bleeding (aOR: 2.1, 95 % CI: 1.9-2.3, p < 0.001), and hematuria (aOR: 10.8, 95 % CI: 9.4-12.4, p < 0.001). Frail patients had higher 30-day readmissions compared to non-frail patients (aOR: 1.2, 95 % CI: 1.1-1.2, p < 0.001), longer lengths of stay (6.1 vs. 3.6 days, p < 0.001), and higher total charges ($61,100 vs. $36,370, p < 0.001).

Conclusion: Frailty significantly increases mortality and adverse events in elderly patients hospitalized with acute PE, particularly in non-high-risk individuals. These findings highlight the necessity of frailty assessment to optimize management decisions and guide therapeutic strategies in this vulnerable population.