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Title: Utility of the Hospital Frailty Risk Score Derived From Administrative Data and the Association With Stroke Outcomes.
Austin Authors: Kilkenny, Monique F;Phan, Hoang T;Lindley, Richard I;Kim, Joosup;Lopez, Derrick;Dalli, Lachlan L;Grimley, Rohan;Sundararajan, Vijaya;Thrift, Amanda G;Andrew, Nadine E;Donnan, Geoffrey A ;Cadilhac, Dominique A
Affiliation: Sunshine Coast Clinical School, Griffith University, Birtinya, Queensland, Australia
Menzies Institute for Medical Research, University of Tasmania, Australia
George Institute for Global Health, Sydney, New South Wales, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
School of Population and Global Health, The University of Western Australia, Perth, Australia
Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
Department of Medicine, Peninsula Clinical School, Monash University, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health
Issue Date: 2021 2021
Publication information: Stroke 2021; 52(9): 2874-2881
Abstract: Conditions associated with frailty are common in people experiencing stroke and may explain differences in outcomes. We assessed associations between a published, generic frailty risk score, derived from administrative data, and patient outcomes following stroke/transient ischemic attack; and its accuracy for stroke in predicting mortality compared with other measures of clinical status using coded data. Patient-level data from the Australian Stroke Clinical Registry (2009-2013) were linked with hospital admissions data. We used International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes with a 5-year look-back period to calculate the Hospital Frailty Risk Score (termed Frailty Score hereafter) and summarized results into 4 groups: no-risk (0), low-risk (1-5), intermediate-risk (5-15), and high-risk (>15). Multilevel models, accounting for hospital clustering, were used to assess associations between the Frailty Score and outcomes, including mortality (Cox regression) and readmissions up to 90 days, prolonged acute length of stay (>20 days; logistic regression), and health-related quality of life at 90 to 180 days (quantile regression). The performance of the Frailty Score was then compared with the Charlson and Elixhauser Indices using multiple tests (eg, C statistics) for predicting 30-day mortality. Models were adjusted for covariates including sociodemographics and stroke-related factors. Among 15 468 adult patients, 15% died ≤90 days. The frailty scores were 9% no risk; 23% low, 45% intermediate, and 22% high. A 1-point increase in frailty (continuous variable) was associated with greater length of stay (ORadjusted, 1.05 [95% CI, 1.04 to 1.06), 90-day mortality (HRadjusted, 1.04 [95% CI, 1.03 to 1.05]), readmissions (ORadjusted, 1.02 [95% CI, 1.02 to 1.03]; and worse health-related quality of life (median difference, -0.010 [95% CI -0.012 to -0.010]). Adjusting for the Frailty Score provided a slightly better explanation of 30-day mortality (eg, larger C statistics) compared with other indices. Greater frailty was associated with worse outcomes following stroke/transient ischemic attack. The Frailty Score provides equivalent precision compared with the Charlson and Elixhauser indices for assessing risk-adjusted outcomes following stroke/transient ischemic attack.
DOI: 10.1161/STROKEAHA.120.033648
PubMed URL: 34134509
Type: Journal Article
Subjects: hospitalization
ischemic attack, transient
risk factor
Appears in Collections:Journal articles

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