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Impact of Frailty on Emergency Department Encounters for Cardiovascular Disease: A Retrospective Cohort Study

Sokhal, Balamrit Singh; Matetić, Andrija; Abhishek, Abhishek; Banerjee, Amitava; Partington, Richard; Roddy, Edward; Rashid, Muhammad; Mallen, Christian David; Mamas, Mamas Andreas


Balamrit Singh Sokhal

Andrija Matetić

Abhishek Abhishek

Amitava Banerjee

Richard Partington


Data are limited on whether the causes of emergency department (ED) encounters for cardiovascular diseases (CVDs) and associated clinical outcomes vary by frailty status. Using the United States Nationwide ED Sample, selected CVD encounters (acute myocardial infarction [AMI], ischemic stroke, atrial fibrillation [AF], heart failure [HF], pulmonary embolism, cardiac arrest, and hemorrhagic stroke) were stratified by hospital frailty risk score (HFRS). Logistic regression was used to determine the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of ED mortality among the different frailty groups. A total of 8,577,028 selected CVD ED encounters were included. A total of 5,120,843 (59.7%) had a low HFRS (<5), 3,041,699 (35.5%) had an intermediate HFRS (5 to 15), and 414,485 (4.8%) had a high HFRS (>15). Ischemic stroke was the most common reason for the encounter in the high HFRS group (66.9%), followed by hemorrhagic stroke (11.7%) and AMI (7.2%). For the low HFRS group, AF was the most common reason for the encounter (30.2%), followed by AMI (23.6%) and HF (16.8%). Compared with the low-risk group, high-risk patients had a decreased ED mortality and an increased overall mortality across most CVD encounters (p <0.001). The strongest association with overall mortality was observed among patients with a high HFRS admitted for AF (aOR 27.14, 95% CI 25.03 to 29.43) and HF (aOR 13.71, 95% CI 12.95 to 14.51) compared with their low-risk counterparts. In conclusion, patients presenting to the ED with acute CVD have a significant frailty burden, with different patterns of CVD according to frailty status. Frailty is associated with an increased all-cause mortality in patients for most CVD encounters.

Journal Article Type Article
Acceptance Date Sep 13, 2023
Online Publication Date Sep 13, 2023
Publication Date Nov 1, 2023
Deposit Date Oct 4, 2023
Journal The American Journal of Cardiology
Print ISSN 0002-9149
Electronic ISSN 1879-1913
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 206
Pages 210-218
Keywords cardiovascular disease; emergency department; frailty; mortality