Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 5;12(17):e030294.
doi: 10.1161/JAHA.123.030294. Epub 2023 Aug 29.

Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb-Threatening Ischemia

Monil Majmundar  1 , Kunal N Patel  2 , Rajkumar Doshi  3 , Harsh Mehta  1 , Mohinder R Vindhyal  1 , Kirk A Hance  4 , Adam Ali  5 , Kamal Gupta  1
Affiliations

Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb-Threatening Ischemia

Monil Majmundar et al. J Am Heart Assoc. .

Abstract

Background The impact of medical record-based frailty assessment on clinical outcomes in patients undergoing revascularization for critical limb-threatening ischemia (CLTI) is unknown. Methods and Results This study included patients with CLTI aged ≥18 years from the nationwide readmissions database 2016 to 2018 who underwent endovascular revascularization (ER) or surgical revascularization (SR). The hospital frailty risk score, a previously validated International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) claims-based score, was used to categorize patients into low- (<5), intermediate- (5-15), and high-risk (>15) frailty categories. Primary outcomes were in-hospital mortality and major amputation at 6 months. A total of 64 338 patients were identified who underwent ER (82.3%) or SR (17.7%) for CLTI. The mean (SD) age of the cohort was 69.3 (11.8) years, and 63% of patients were male. This study found a nonlinear association between hospital frailty risk score and in-hospital mortality and 6-month major amputation. In both ER and SR cohorts, the intermediate- and high-risk groups were associated with a significantly higher risk of in-hospital mortality (high-risk group: ER: odds ratio [OR], 7.2 [95% CI, 4.4-11.6], P<0.001; SR: OR, 28.6 [95% CI, 3.4-237.6], P=0.002) and major amputation at 6 months (high-risk group: ER: hazard ratio [HR], 1.6 [95% CI, 1.5-1.7], P<0.001; SR: HR, 1.7 [95% CI, 1.4-2.2], P<0.001) compared with the low-risk group. Conclusions The hospital frailty risk score, generated from the medical record, can identify frailty and predict in-hospital mortality and 6-month major amputation in patients undergoing ER or SR for CLTI. Further studies are needed to assess if this score can be incorporated into clinical decision-making in patients undergoing revascularization for CLTI.

Keywords: amputation; chronic limb‐threatening ischemia; endovascular revascularization; frail elderly; frailty; mortality; surgical revascularization.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Patient selection flow chart.
ICD‐10‐CM indicates International Classification of Diseases, Tenth Revision, Clinical Modification; and NRD, nationwide readmissions database.
Figure 2
Figure 2. Relationship of HFR score with in‐hospital mortality and 180‐day major amputation after ER or SR in patients with critical limb–threatening ischemia.
A, In‐hospital mortality. B, 180‐day major amputation. Nonlinear increasing trends for in‐hospital mortality and 6‐month major amputation against HFR score on restricted cubic spline curves. The definition of 180‐day major amputation included both in‐hospital and postdischarge amputation. ER indicates endovascular revascularization; HFR, hospital frailty risk; and SR, surgical revascularization.
Figure 3
Figure 3. Relationship of HFR score with in‐hospital morbidity, 180‐day unplanned readmission, 180‐day readmission due to MACE, and 180‐day readmission mortality after ER or SR in patients with critical limb–threatening ischemia.
A, In‐hospital morbidity. B, 180‐day unplanned readmission. C, 180‐day readmission due to MACE. D, 180‐day readmission mortality. Nonlinear increasing trends for in‐hospital morbidity, 180‐day unplanned readmission, 180‐day readmission due to MACE, and 180‐day readmission mortality against HFR score on restricted cubic spline curves. The 180‐day outcomes were derived from competing risk analysis, and the nationwide readmission database does not capture mortality out of the hospital, which could be the reason for the flattening of spline curves in the high‐risk category. ER indicates endovascular revascularization; HFR, hospital frailty risk; MACE, major adverse cardiovascular events; and SR, surgical revascularization.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Mustapha JA, Katzen BT, Neville RF, Lookstein RA, Zeller T, Miller LE, Jaff MR. Determinants of long‐term outcomes and costs in the management of critical limb ischemia: a population‐based cohort study. J Am Heart Assoc. 2018;7:e009724. doi: 10.1161/JAHA.118.009724 - DOI - PMC - PubMed
    1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group . Inter‐society consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45:S5–67. doi: 10.1016/j.jvs.2006.12.037 - DOI - PubMed
    1. Biancari F, Salenius J‐P, Heikkinen M, Luther M, Ylönen K, Lepäntalo M. Risk‐scoring method for prediction of 30‐day postoperative outcome after infrainguinal surgical revascularization for critical lower‐limb ischemia: a Finnvasc registry study. World J. Surg. 2007;31:217–225. doi: 10.1007/s00268-006-0242-y - DOI - PubMed
    1. Schanzer A, Mega J, Meadows J, Samson RH, Bandyk DF, Conte MS. Risk stratification in critical limb ischemia: derivation and validation of a model to predict amputation‐free survival using multicenter surgical outcomes data. J Vasc Surg. 2008;48:1464–1471. doi: 10.1016/j.jvs.2008.07.062 - DOI - PMC - PubMed
    1. Moxey PW, Brownrigg J, Kumar SS, Crate G, Holt PJ, Thompson MM, Jones KG, Hinchliffe RJ. The BASIL survival prediction model in patients with peripheral arterial disease undergoing revascularization in a university hospital setting and comparison with the FINNVASC and modified PREVENT scores. J Vasc Surg. 2013;57:1–7. doi: 10.1016/j.jvs.2012.04.074 - DOI - PubMed
-