Frailty and Function in Heart Failure: Predictors of 30-Day Hospital Readmission?
Tamra Keeney, Diane U Jette, Howard Cabral and 1 others
PMID 31373945WHAT IT FOUND
Lower physical function and higher frailty scores were associated with a greater risk of hospital readmission in older adults with heart failure.
However, no specific score on either measure could accurately identify which patients would be readmitted within 30 days.
Key findings
01Participants who were readmitted to the hospital had significantly lower mean scores on the Short Physical Performance Battery (SPPB) compared to those who were not readmitted.
02A higher proportion of individuals who were readmitted were classified as frail using the Physical Frailty Phenotype compared to those who were not readmitted.
03Neither the SPPB nor the frailty measure demonstrated adequate ability to discriminate between patients who experienced readmission and those who did not, with accuracy scores below the accepted clinical threshold.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study could not account for the severity or specific cause of heart failure, which might influence function and frailty. Function and frailty were measured at a single point in time (the beginning of the study period) and not immediately before or after hospitalization, so changes in status near the time of readmission were missed. The study was observational, meaning it can show associations but cannot prove that low function or frailty causes readmissions. 214 participants were excluded due to missing data, which may have reduced the study's power to detect true effects. The time gap between the assessment and the readmission varied, with an average of 190 days passing, which may weaken the link between the measured status and the outcome.
Declared interests
The study was supported by the National Institute on Aging (grant number NIA U01AG32947). No other conflicts of interest were reported.
The easy way to misread this
Do not assume that a low SPPB or high frailty score means a patient is certain to be readmitted. While these scores are associated with higher risk on a population level, the study showed they are not accurate enough to predict individual readmissions. A patient with a 'good' score can still be readmitted, and a patient with a 'poor' score might not be.