Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study

John Muscedere; Sean M Bagshaw; Michelle Kho; Sangeeta Mehta; Deborah J Cook; J Gordon Boyd; Stephanie Sibley; Han T Wang; Patrick M Archambault; Martin Albert; Oleksa G Rewa; Ian Ball; Patrick A Norman; Andrew G Day; Miranda Hunt; Osama Loubani; Tina Mele; Aimee J Sarti; Jason Shahin; Canadian Critical Care Trials Group

doi:10.1007/s00134-024-07404-9

Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study

Intensive Care Med. 2024 May 15. doi: 10.1007/s00134-024-07404-9. Online ahead of print.

Authors

John Muscedere¹, Sean M Bagshaw², Michelle Kho³, Sangeeta Mehta⁴, Deborah J Cook⁵, J Gordon Boyd⁶, Stephanie Sibley⁷, Han T Wang⁸, Patrick M Archambault^{9

10}, Martin Albert¹¹, Oleksa G Rewa², Ian Ball¹², Patrick A Norman¹³, Andrew G Day¹³, Miranda Hunt⁷, Osama Loubani¹⁴, Tina Mele¹⁵, Aimee J Sarti¹⁶, Jason Shahin¹⁷; Canadian Critical Care Trials Group

Affiliations

¹ Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. John.Muscedere@kingstonhsc.ca.
² Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada.
³ School of Rehabilitation Science, Faculty of Health Science, Physiotherapy Department, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada.
⁴ Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada.
⁵ Departments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
⁶ Department of Medicine (Neurology) and Critical Care Medicine, Queen's University, Kingston, ON, Canada.
⁷ Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
⁸ Division of Critical Care Medicine, Department of Medicine, Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada.
⁹ Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
¹⁰ Department of Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Québec, QC, Canada.
¹¹ Division of Critical Care Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal Research Center and Université de Montréal, Montreal, QC, Canada.
¹² Department of Medicine and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
¹³ Kingston General Health Research Institute and Kingston Health Sciences Centre, Kingston, Canada.
¹⁴ Department of Critical Care, Dalhousie University, Halifax, ON, Canada.
¹⁵ Department of Surgery, University of Western Ontario, London, ON, Canada.
¹⁶ Department of Critical Care, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹⁷ Department of Medicine, McGill University, Montreal, Qc, Canada.

PMID: 38748266
DOI: 10.1007/s00134-024-07404-9

Abstract

Purpose: Frailty is common in critically ill patients but the timing and optimal method of frailty ascertainment, trajectory and relationship with care processes remain uncertain. We sought to elucidate the trajectory and care processes of frailty in critically ill patients as measured by the Clinical Frailty Scale (CFS) and Frailty Index (FI).

Methods: This is a multi-centre prospective cohort study enrolling patients ≥ 50 years old receiving life support > 24 h. Frailty severity was assessed with a CFS, and a FI based on the elements of a comprehensive geriatric assessment (CGA) at intensive care unit (ICU) admission, hospital discharge and 6 months. For the primary outcome of frailty prevalence, it was a priori dichotomously defined as a CFS ≥ 5 or FI ≥ 0.2. Processes of care, adverse events were collected during ICU and ward stays while outcomes were determined for ICU, hospital, and 6 months.

Results: In 687 patients, whose age (mean ± standard deviation) was 68.8 ± 9.2 years, frailty prevalence was higher when measured with the FI (CFS, FI %): ICU admission (29.8, 44.8), hospital discharge (54.6, 67.9), 6 months (34.1, 42.6). Compared to ICU admission, aggregate frailty severity increased to hospital discharge but improved by 6 months; individually, CFS and FI were higher in 45.3% and 50.6% patients, respectively at 6 months. Compared to hospital discharge, 18.7% (CFS) and 20% (FI) were higher at 6 months. Mortality was higher in frail patients. Processes of care and adverse events were similar except for worse ICU/ward mobility and more frequent delirium in frail patients.

Conclusions: Frailty severity was dynamic, can be measured during recovery from critical illness using the CFS and FI which were both associated with worse outcomes. Although the CFS is a global measure, a CGA FI based may have advantages of being able to measure frailty levels, identify deficits, and potential targets for intervention.

Keywords: Clinical Frailty Scale; Frailty; Frailty Index; Outcomes; Process measures.