(166) Clinical Outcomes and Treatment Pattern of Older Patients with Heart Failure Across Different Frailty Severity Status: a Nationwide Cohort Study of 38,843 Newly Hospitalized Heart Failure Patients

Publication Number: 827

Background: Frailty often coexists with heart failure (HF) and aggravate clinical outcomes. However, studies focused on the impacts of frailty on healthcare utilizations, treatment patterns, and clinical outcomes across different frailty status in older HF patients are scarce in Asia.

Objectives: In this study, we aimed to use the multimorbidity frailty index developed using ICD-10 CM codes (mFI-v10) to estimate the impact of frailty on healthcare utilization, treatment pattern and mortality among newly admitted HF older patients.

Methods: From Taiwan’s National Health Insurance Research Database (NHIRD), patients aged 65 years and older who were newly admitted for HF (index event) and discharged from the index event in 2018 were identified. Frailty was defined by mFI-v10. Healthcare utilizations and prescriptions for the following HF-related medications (angiotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), angiotensin receptor-neprilysin inhibitor (ARNI), β-blockers, aldosterone antagonists, loop diuretics, thiazides) for each study subject in the year preceding the index event (12 months), at the incident HF admission, and the year after discharge from the incident HF admission (12 months) were retrieved. Outcomes of interest included all-cause mortality, all-cause readmissions, and readmissions due to HF. Cox regression models and Fine and Gray subdistribution hazard model were used to estimate the impacts of frailty on outcomes of interest.

Results: Of 38,843 HF patients (mean age 80.4±8.5 years, 52.3% females) identified, 84.5% were categorized as frail (51.9 % mild-, 26.9 % moderate-, and 5.7% severe frailty). The readmissions increased as the severity of frailty progressed, with the mean hospital admissions were 1.2±1.6, 1.4±1.7, 1.7±1.8, and 2.1±2.2 for fit, mildly frail, moderately frail, and severely frail older HF patients. The prescribing rate of any HF-related medications was 45.0% at one year prior to the index HF admissions. A total of 32,363 patients (83.3%) were prescribed HF-related medications at the index HF admissions. Nevertheless, such use decreased after discharge from the index HF admissions. Those in the severe frailty group were at higher risk of mortality (2-year mortality risk: aHR 1.19 (95% CI 1.11-1.28)), all-cause readmissions (sHR 1.27 (1.20-1.35)) and readmissions due to HF [sHR 1.26 (1.17-1.36)).

Conclusions: Frailty was prevalent among older HF patients and aggravated clinical outcomes (all-cause mortality, readmissions, and HF readmissions). However, the utilization of the HF-related medications differ across the clinical course. Further studies are needed to explore the treatment strategy for older HF patients with different frailty status.