Advertisement

Frailty and associated outcomes and resource utilization following in-hospital cardiac arrest

  • Shannon M. Fernando
    Correspondence
    Corresponding author at: Department of Critical Care, The Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa, ON, K1Y 4E9, Canada.
    Affiliations
    Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
    Search for articles by this author
  • Daniel I. McIsaac
    Affiliations
    Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada

    School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
    Search for articles by this author
  • Bram Rochwerg
    Affiliations
    Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada

    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
    Search for articles by this author
  • Deborah J. Cook
    Affiliations
    Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada

    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
    Search for articles by this author
  • Sean M. Bagshaw
    Affiliations
    Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
    Search for articles by this author
  • John Muscedere
    Affiliations
    Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada
    Search for articles by this author
  • Laveena Munshi
    Affiliations
    Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada

    Department of Medicine, Sinai Health System, Toronto, ON, Canada
    Search for articles by this author
  • Jerry P. Nolan
    Affiliations
    Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK

    Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
    Search for articles by this author
  • Jeffrey J. Perry
    Affiliations
    Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
    Search for articles by this author
  • James Downar
    Affiliations
    Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Bruyere Research Institute, Ottawa, ON, Canada

    Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
    Search for articles by this author
  • Chintan Dave
    Affiliations
    Department of Medicine, University of Ottawa, Ottawa, ON, Canada
    Search for articles by this author
  • Peter M. Reardon
    Affiliations
    Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
    Search for articles by this author
  • Peter Tanuseputro
    Affiliations
    School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Bruyere Research Institute, Ottawa, ON, Canada

    Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
    Search for articles by this author
  • Kwadwo Kyeremanteng
    Affiliations
    Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Bruyere Research Institute, Ottawa, ON, Canada

    Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Institut du Savoir Montfort, Ottawa, ON, Canada
    Search for articles by this author

      Abstract

      Background

      In-hospital cardiac arrest (IHCA) is common and associated with high mortality. Frailty is increasingly recognized as a predictor of worse prognosis among critically ill patients, but its association with outcomes and resource utilization following IHCA is unknown.

      Methods

      We performed a retrospective analysis (2013–2016) of a prospectively collected registry from two hospitals of consecutive hospitalized adult patients with IHCA occurring on the hospital wards. We defined frailty using the Clinical Frailty Scale (CFS) score ≥5. CFS scores were based on validated medical review criteria. The primary outcome is hospital mortality. Secondary outcomes include return of spontaneous circulation (ROSC), discharge to long-term care, and hospital costs. We used multivariable logistic regression to adjust for known confounders.

      Results

      We included 477 patients, and 124 (26.0%) had frailty. Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 2.91 [95% confidence interval [CI]: 2.37–3.48) and discharge to long-term care (aOR 1.94 [95% CI: 1.57–2.32]). Compared with patients without frailty, patients with frailty had decreased odds of ROSC following IHCA (aOR 0.63 [95% CI: 0.41–0.93]). No difference in mean total costs was demonstrated between patients with and without frailty ($50,799 vs. $45,849). Frail patients did have higher cost-per-survivor ($947,546 vs. $161,550).

      Conclusions

      Frail individuals who experience an IHCA are more likely to die in hospital or be discharged to long-term care, and less likely to achieve ROSC in comparison with individuals who are not frail. The hospital costs per-survivor of IHCA are increased when frailty is present.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Andersen L.W.
        • Holmberg M.J.
        • Berg K.M.
        • Donnino M.W.
        • Granfeldt A.
        In-hospital cardiac arrest: a review.
        JAMA. 2019; 321: 1200-1210
        • Morrison L.J.
        • Neumar R.W.
        • Zimmerman J.L.
        • et al.
        Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association.
        Circulation. 2013; 127: 1538-1563
        • Hodgetts T.J.
        • Kenward G.
        • Vlackonikolis I.
        • et al.
        Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital.
        Resuscitation. 2002; 54: 115-123
        • Nolan J.P.
        • Ferrando P.
        • Soar J.
        • et al.
        Increasing survival after admission to UK critical care units following cardiopulmonary resuscitation.
        Crit Care. 2016; 20: 219
        • Zhu A.
        • Zhang J.
        Meta-analysis of outcomes of the 2005 and 2010 cardiopulmonary resuscitation guidelines for adults with in-hospital cardiac arrest.
        Am J Emerg Med. 2016; 34: 1133-1139
        • Schluep M.
        • Gravesteijn B.Y.
        • Stolker R.J.
        • Endeman H.
        • Hoeks S.E.
        One-year survival after in-hospital cardiac arrest: a systematic review and meta-analysis.
        Resuscitation. 2018; 132: 90-100
        • Fernando S.M.
        • Tran A.
        • Cheng W.
        • et al.
        Pre- and intra-arrest prognostic factors associated with survival following in-hospital cardiac arrest: systematic review and meta-analysis.
        BMJ. 2019;
        • Moskowitz A.
        • Holmberg M.J.
        • Donnino M.W.
        • Berg K.M.
        In-hospital cardiac arrest: are we overlooking a key distinction?.
        Curr Opin Crit Care. 2018; 24: 151-157
        • Clegg A.
        • Young J.
        • Iliffe S.
        • Rikkert M.O.
        • Rockwood K.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-56
        • Kehler D.S.
        • Ferguson T.
        • Stammers A.N.
        • et al.
        Prevalence of frailty in Canadians 18-79 years old in the Canadian Health Measures Survey.
        BMC Geriatr. 2017; 17: 28
        • Bagshaw M.
        • Majumdar S.R.
        • Rolfson D.B.
        • Ibrahim Q.
        • McDermid R.C.
        • Stelfox H.T.
        A prospective multicenter cohort study of frailty in younger critically ill patients.
        Crit Care. 2016; 20: 175
        • Rockwood K.
        • Song X.
        • MacKnight C.
        • et al.
        A global clinical measure of fitness and frailty in elderly people.
        CMAJ. 2005; 173: 489-495
        • Bagshaw S.M.
        • Stelfox H.T.
        • McDermid R.C.
        • et al.
        Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study.
        CMAJ. 2014; 186: E95-102
        • Le Maguet P.
        • Roquilly A.
        • Lasocki S.
        • et al.
        Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study.
        Intensive Care Med. 2014; 40: 674-682
        • Brummel N.E.
        • Bell S.P.
        • Girard T.D.
        • et al.
        Frailty and subsequent disability and mortality among patients with critical illness.
        Am J Respir Crit Care Med. 2017; 196: 64-72
        • Zampieri F.G.
        • Iwashyna T.J.
        • Viglianti E.M.
        • et al.
        Association of frailty with short-term outcomes, organ support and resource use in critically ill patients.
        Intensive Care Med. 2018; 44: 1512-1520
        • Fernando S.M.
        • McIsaac D.I.
        • Perry J.J.
        • et al.
        Frailty and associated outcomes and resource utilization among older ICU patients with suspected infection.
        Crit Care Med. 2019; 47: e669-e676
        • Fernando S.M.
        • McIsaac D.I.
        • Rochwerg B.
        • et al.
        Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy.
        Intensive Care Med. 2019;
        • Muscedere J.
        • Waters B.
        • Varambally A.
        • et al.
        The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis.
        Intensive Care Med. 2017; 43: 1105-1122
        • Chan P.S.
        • Nallamothu B.K.
        • Krumholz H.M.
        • et al.
        Long-term outcomes in elderly survivors of in-hospital cardiac arrest.
        N Engl J Med. 2013; 368: 1019-1026
        • Elshaug A.G.
        • Rosenthal M.B.
        • Lavis J.N.
        • et al.
        Levers for addressing medical underuse and overuse: achieving high-value health care.
        Lancet. 2017; 390: 191-202
        • Stelfox H.T.
        • Bourgault A.M.
        • Niven D.J.
        De-implementing low value care in critically ill patients: a call for action-less is more.
        Intensive Care Med. 2019;
        • Fernando S.M.
        • Reardon P.M.
        • Rochwerg B.
        • et al.
        Sepsis-3 septic shock criteria and associated mortality among infected hospitalized patients assessed by a rapid response team.
        Chest. 2018; 154: 309-316
        • Fernando S.M.
        • Reardon P.M.
        • Dowlatshahi D.
        • et al.
        Outcomes and costs of patients admitted to the ICU due to spontaneous intracranial hemorrhage.
        Crit Care Med. 2018; 46: e395-e403
        • Fernando S.M.
        • Reardon P.M.
        • McIsaac D.I.
        • et al.
        Outcomes of older hospitalized patients requiring rapid response team activation for acute deterioration.
        Crit Care Med. 2018; 46: 1953-1960
        • Nolan J.P.
        • Soar J.
        • Smith G.B.
        • et al.
        Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit.
        Resuscitation. 2014; 85: 987-992
        • Elixhauser A.
        • Steiner C.
        • Harris D.R.
        • Coffey R.M.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Marshall J.C.
        • Cook D.J.
        • Christou N.V.
        • Bernard G.R.
        • Sprung C.L.
        • Sibbald W.J.
        Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.
        Crit Care Med. 1995; 23: 1638-1652
        • Fernando S.M.
        • Rochwerg B.
        • Reardon P.M.
        • et al.
        Emergency department disposition decisions and associated mortality and costs in ICU patients with suspected infection.
        Crit Care. 2018; 22: 172
        • Ronksley P.E.
        • McKay J.A.
        • Kobewka D.M.
        • Mulpuru S.
        • Forster A.J.
        Patterns of health care use in a high-cost inpatient population in Ottawa, Ontario: a retrospective observational study.
        CMAJ Open. 2015; 3: E111-8
        • Reis Miranda D.
        • Moreno R.
        • Iapichino G.
        Nine equivalents of nursing manpower use score (NEMS).
        Intensive Care Med. 1997; 23: 760-765
        • Shears M.
        • Takaoka A.
        • Rochwerg B.
        • et al.
        Assessing frailty in the intensive care unit: a reliability and validity study.
        J Crit Care. 2018; 45: 197-203
        • Worster A.
        • Haines T.
        Advanced statistics: understanding medical record review (MRR) studies.
        Acad Emerg Med. 2004; 11: 187-192
        • Lederer D.J.
        • Bell S.C.
        • Branson R.D.
        • et al.
        Control of confounding and reporting of results in causal inference studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care Journals.
        Ann Am Thorac Soc. 2019; 16: 22-28
        • Hirlekar G.
        • Karlsson T.
        • Aune S.
        • et al.
        Survival and neurological outcome in the elderly after in-hospital cardiac arrest.
        Resuscitation. 2017; 118: 101-106
        • van Gijn M.S.
        • Frijns D.
        • van de Glind E.M.
        • CvM B.
        • Hamaker M.E.
        The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review.
        Age Ageing. 2014; 43: 456-463
        • Bruckel J.T.
        • Wong S.L.
        • Chan P.S.
        • Bradley S.M.
        • Nallamothu B.K.
        Patterns of resuscitation care and survival after in-hospital cardiac arrest in patients with advanced cancer.
        J Oncol Pract. 2017; 13: e821-e830
        • Smith R.J.
        • Reid D.A.
        • Santamaria J.D.
        Frailty is associated with reduced prospect of discharge home after in-hospital cardiac arrest.
        Intern Med J. 2018;
        • Wharton C.
        • King E.
        • MacDuff A.
        Frailty is associated with adverse outcome from in-hospital cardiopulmonary resuscitation.
        Resuscitation. 2019;
        • Murphy D.J.
        • Burrows D.
        • Santilli S.
        • et al.
        The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation.
        N Engl J Med. 1994; 330: 545-549
        • Diem S.J.
        • Lantos J.D.
        • Tulsky J.A.
        Cardiopulmonary resuscitation on television. Miracles and misinformation.
        N Engl J Med. 1996; 334: 1578-1582
        • McIsaac D.I.
        • Taljaard M.
        • Bryson G.L.
        • et al.
        Frailty as a predictor of death or new disability after surgery: a prospective cohort study.
        Ann Surg. 2018;
        • Kyeremanteng K.
        • Downar J.
        Why is it so hard to stop doing things that are unwanted, non-beneficial, or unsustainable?.
        Lancet Respir Med. 2019; 7: 558-560
        • Fernando S.M.
        • Qureshi D.
        • Tanuseputro P.
        • et al.
        Mortality and costs following extracorporeal membrane oxygenation in critically ill adults: a population-based cohort study.
        Intensive Care Med. 2019; 45: 1580-1589
        • Haywood K.
        • Whitehead L.
        • Nadkarni V.M.
        • et al.
        COSCA (Core Outcome Set for Cardiac Arrest) in adults: an advisory statement from the International Liaison Committee on Resuscitation.
        Resuscitation. 2018; 127: 147-163