Impact of Frailty and Delirium Among Older Adults Admitted With Acute Decompensated Heart Failure

Abstract

Background: The presence of frailty or delirium among patients hospitalized for acute decompensated heart failure (ADHF) is associated with increased mortality and prolonged hospital stay. Objectives: The purpose of this study was to assess the combined effect of frailty and delirium on in-hospital mortality and disposition at discharge among older adults hospitalized with ADHF. Methods: We conducted a retrospective observational study using Nationwide Inpatient Sample data from the Agency for Healthcare Research and Quality from 2016 to 2018. Patients aged 65 years or older with a diagnosis of ADHF (both with preserved and reduced left ventricular ejection fraction) were included. For analysis, we conducted a multivariable logistic regression analysis to determine OR for in-hospital mortality or nonhome discharge from delirium and frailty. Results: A total of 3,577,433 weighted number of hospitalizations with ADHF were included. Delirium, moderate frailty risk, and high frailty risk increased the OR for in-hospital mortality (3.74; 95% CI: 3.70-3.78, 4.02; 95% CI: 3.96-4.09, and 8.63; 95% CI: 8.47-8.78, respectively) and nonhome discharge (4.21; 95% CI: 4.18-4.25, 2.95; 95% CI: 2.94-2.97, and 8.86; 95% CI: 8.78-8.94, respectively). When the combination of delirium and frailty was assessed, compared to those without delirium and with low frailty risk, the OR of mortality among those with delirium and high frailty risk was the highest at 12.18 (95% CI: 11.89-12.48). For nonhome discharge, the OR was the highest among those with delirium and high frailty risk at 14.01 (95% CI: 13.77-14.26). Conclusions: Frailty and delirium, independently and in combination, led to higher odds of in-hospital mortality and nonhome disposition at discharge among patients hospitalized with ADHF.

Keywords

• acute decompensated heart failure
• delirium
• disposition at discharge
• frailty
• mortality
• older adults