Do Rockwood frailty score and Charlson comorbidity index help to risk stratify outpatient versus inpatient management of acute decompensated heart failure?

Abstract Introduction Acute decompensated heart failure (ADHF) is associated with frailty and co-morbidities which influence prognosis. The Rockwood Frailty Score (RFS) and age-adjusted Charlson co-morbidity index (CCI) have been used to predict outcomes in hospitalised ADHF patients. Purpose To describe the relationship of CCI, RFS and clinical risk score -Get With The Guidelines Score (GWTG) with mortality in ADHF treated as outpatients (OP) versus hospitalised inpatients (IP). Methods This retrospective analysis compared 2 cohorts of consecutive ADHF patients - hospitalised in-patients (IP) versus outpatients (OP) who were treated with bolus intravenous diuretics in a specialist heart failure nurse delivered OP HF unit (Ambulatory HF Unit -AHFU) with input from various specialties (renal, palliative, ascitic, pleural teams) from Nov 16 to Dec 17. Mean follow-up duration was similar for both groups (IP=19.5±4.1 months; OP=19.3±3.9 months, p=0.6). Mortality was compared at 1, 3 and 12 months based on RFS (no frailty <5, mild to moderate frailty 5/6, severe frailty - 7 to 9). Results were expressed as mean±SD and analysed using One-Way ANOVA and Chi-squared with Fisher's exact test test. Results 410 consecutive patients (482 admissions) were hospitalised (inpatients -IP) and 231 OP (289 OP visits) were treated in the AHFU. IP group had significantly higher mean CCI (IP=6.55±2; OP=6.10±1.9; p=0.006) and mean RFS (IP 5.2±1.2; OP 4.9±1.1; p=0.002). Mean Clinical Risk Score GWTG was similar (IP=38.9±7.2; OP=38.4±6.6; p=0.44). Mean survival was significantly lower in IP (IP=378±270 days; OP=437±228; P=0.003). As shown in the table higher RFS predicts increased mortality risk (1 month, 3 month and 12 month). Conclusions Rockwood Frailty Score predicts mortality in ADHF and assessment of RFS can play an important role in risk stratifying and decision-making in addition to clinical risk-scores, with regards to suitability for outpatient treatment of ADHF. Funding Acknowledgement Type of funding source: None