Background: frailty measurement may identify patients at risk of decline after hospital discharge, but many measures require specialist review and/or additional testing.
Objective: to compare validated frailty tools with routine electronic health record (EHR) data at hospital discharge, for associations with readmission or death.
Design: observational cohort study.
Setting: hospital ward.
Subjects: consented cardiology inpatients ≥70 years old within 24 hours of discharge.
Methods: patients underwent Fried, Short Physical Performance Battery (SPPB), PRISMA-7 and Clinical Frailty Scale (CFS) assessments. An EHR risk score was derived from the proportion of 31 possible frailty markers present. Electronic follow-up was completed for a primary outcome of 90-day readmission or death. Secondary outcomes were mortality and days alive at home ('home time') at 12 months.
Results: in total, 186 patients were included (79 ± 6 years old, 64% males). The primary outcome occurred in 55 (30%) patients. Fried (hazard ratio [HR] 1.47 per standard deviation [SD] increase, 95% confidence interval [CI] 1.18-1.81, P < 0.001), CFS (HR 1.24 per SD increase, 95% CI 1.01-1.51, P = 0.04) and EHR risk scores (HR 1.35 per SD increase, 95% CI 1.02-1.78, P = 0.04) were independently associated with the primary outcome after adjustment for age, sex and co-morbidity, but the SPPB and PRISMA-7 were not. The EHR risk score was independently associated with mortality and home time at 12 months.
Conclusions: frailty measurement at hospital discharge identifies patients at risk of poorer outcomes. An EHR-based risk score appeared equivalent to validated frailty tools and may be automated to screen patients at scale, but this requires further validation.
Keywords: co-morbidity; frailty; older people; risk prediction.
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society.