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RESUSCITATION JOURNAL COVERFrailty 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

 

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.

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