TY - JOUR
T1 - Developing a Parsimonious Frailty Index for Older, Multimorbid Adults With Heart Failure Using Machine Learning
AU - Razjouyan, Javad
AU - Horstman, Molly J.
AU - Orkaby, Ariela R.
AU - Virani, Salim S.
AU - Intrator, Orna
AU - Goyal, Parag
AU - Amos, Christopher I.
AU - Naik, Aanand D.
N1 - Funding Information:
The authors are grateful to the VA Informatics and Computing Infrastructure. The analysis was partly supported by the use of facilities and resources at the Center for Innovations in Quality, Effectiveness and Safety, CIN 13-413, Michael E. DeBakey VA Medical Center, Houston, Texas and a National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Maryland, K25 funding, number 1K25HL152006-01, to Dr. Razjouyan.
Funding Information:
The analysis was partly supported by the use of facilities and resources at the Center for Innovations in Quality, Effectiveness and Safety, CIN 13-413, Michael E. DeBakey VA Medical Center, Houston, Texas and a National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Maryland, K25 funding, number 1K25HL152006-01, to Dr. Razjouyan.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Frailty is associated with adverse outcomes in heart failure (HF). A parsimonious frailty index (FI) that predicts outcomes of older, multimorbid patients with HF could be a useful resource for clinicians. A retrospective study of veterans hospitalized from October 2015 to October 2018 with HF, aged ≥50 years, and discharged home developed a 10-item parsimonious FI using machine learning from diagnostic codes, laboratory results, vital signs, and ejection fraction (EF) from outpatient encounters. An unsupervised clustering technique identified 5 FI strata: severely frail, moderately frail, mildly frail, prefrail, and robust. We report hazard ratios (HRs) of mortality, adjusting for age, gender, race, and EF and odds ratios (ORs) for 30-day and 1-year emergency department visits and all-cause hospitalizations after discharge. We identified 37,431 veterans (age, 73 ± 10 years; co-morbidity index, 5 ± 3; 43.5% with EF ≤40%). All frailty groups had a higher mortality than the robust group: severely frail (HR 2.63, 95% confidence interval [CI] 2.42 to 2.86), moderately frail (HR 2.04, 95% CI 1.87 to 2.22), mildly frail (HR 1.60, 95% CI 1.47 to 1.74), and prefrail (HR 1.18, 95% CI: 1.07 to 1.29). The associations between frailty and mortality remained unchanged in the stratified analysis by age or EF. The combined (severely, moderately, and mildly) frail group had higher odds of 30-day emergency visits (OR 1.62, 95% CI 1.43 to 1.83), all-cause readmission (OR, 1.75, 95% CI 1.52 to 2.02), 1-year emergency visits (OR 1.70, 95% CI 1.53 to 1.89), rehospitalization (OR 2.18, 95% CI 1.97 to 2.41) than the robust group. In conclusion, a 10-item FI is associated with postdischarge outcomes among patients discharged home after a hospitalization for HF. A parsimonious FI may aid clinical prediction at the point of care.
AB - Frailty is associated with adverse outcomes in heart failure (HF). A parsimonious frailty index (FI) that predicts outcomes of older, multimorbid patients with HF could be a useful resource for clinicians. A retrospective study of veterans hospitalized from October 2015 to October 2018 with HF, aged ≥50 years, and discharged home developed a 10-item parsimonious FI using machine learning from diagnostic codes, laboratory results, vital signs, and ejection fraction (EF) from outpatient encounters. An unsupervised clustering technique identified 5 FI strata: severely frail, moderately frail, mildly frail, prefrail, and robust. We report hazard ratios (HRs) of mortality, adjusting for age, gender, race, and EF and odds ratios (ORs) for 30-day and 1-year emergency department visits and all-cause hospitalizations after discharge. We identified 37,431 veterans (age, 73 ± 10 years; co-morbidity index, 5 ± 3; 43.5% with EF ≤40%). All frailty groups had a higher mortality than the robust group: severely frail (HR 2.63, 95% confidence interval [CI] 2.42 to 2.86), moderately frail (HR 2.04, 95% CI 1.87 to 2.22), mildly frail (HR 1.60, 95% CI 1.47 to 1.74), and prefrail (HR 1.18, 95% CI: 1.07 to 1.29). The associations between frailty and mortality remained unchanged in the stratified analysis by age or EF. The combined (severely, moderately, and mildly) frail group had higher odds of 30-day emergency visits (OR 1.62, 95% CI 1.43 to 1.83), all-cause readmission (OR, 1.75, 95% CI 1.52 to 2.02), 1-year emergency visits (OR 1.70, 95% CI 1.53 to 1.89), rehospitalization (OR 2.18, 95% CI 1.97 to 2.41) than the robust group. In conclusion, a 10-item FI is associated with postdischarge outcomes among patients discharged home after a hospitalization for HF. A parsimonious FI may aid clinical prediction at the point of care.
UR - http://www.scopus.com/inward/record.url?scp=85144774946&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2022.11.044
DO - 10.1016/j.amjcard.2022.11.044
M3 - Article
C2 - 36566620
AN - SCOPUS:85144774946
SN - 0002-9149
VL - 190
SP - 75
EP - 81
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -