The impact of frailty on in-hospital outcomes in patients with HFrEF

Frailty is a marker of poor prognosis and is often undertreated and predisposed to adverse outcomes. This study aimed to determine the association between frailty and outcomes in hospitalized patients with heart failure with reduced ejection fraction (HFrEF). A retrospective cross-sectional analysis of the National Inpatient Sample (2016-2020) was conducted to evaluate hospitalizations for HFrEF. Frailty was defined as a hospital frailty risk score of ≥5. Patient demographics, comorbidities, and hospital characteristics were compared between frail and non-frail groups. Multivariable logistic regression, adjusted for confounders, was used to assess the association between frailty and in-hospital outcomes. Among 5,526,303 weighted HFrEF hospitalizations, 53% (n=2,931,329) were classified as frail. Frail patients had a median age of 74 years vs 67 years in non-frail patients. In-hospital mortality was 5.9% in frail vs 1.2% in non-frail patients (adjusted OR [aOR]: 3.8; 95% CI: 3.68-3.92). Adverse events were significantly higher in the frail group, including cardiogenic shock (5.3% vs 2.1%; aOR: 2.58), acute stroke (4.5% vs 0.8%; aOR: 6.63), acute kidney injury (47.8% vs 12.5%; aOR: 5.16), sepsis (13.4% vs 1.6%; aOR: 11.00), major bleeding (4.2% vs 2.0%; aOR: 1.90), acute pulmonary edema (0.47% vs 0.31%; aOR: 1.60), and mechanical ventilation (8.1% vs 1.7%; aOR: 5.33). Additionally, non-home discharge occurred more frequently (35.4% vs 15%; aOR: 2.77), with higher median hospital costs ($46,706 vs $34,793) and prolonged length of stay (5 vs 3 days). Frailty is independently associated with worse in-hospital outcomes in HFrEF patients, underscoring the need for targeted strategies to improve care in this high-risk population.