Identification of Senior At Risk scale predicts 30-day mortality among older patients with acute heart failure

Abstract

Objective: To assess the value of frailty screening tool (Identification of Senior at Risk [ISAR]) in predicting 30-day mortality risk in older patients attended in emergency department (ED) for acute heart failure (AHF).

Design: Observational multicenter cohort study.

Setting: OAK-3 register.

Subjects: Patients aged ≥65 years attended with ADHF in 16 Spanish EDs from January to February 2016.

Intervention: No.

Variables: Variable of study was ISAR scale. The outcome was all-cause 30-day mortality.

Results: We included 1059 patients (mean age 85±5,9 years old). One hundred and sixty (15.1%) cases had 0-1 points, 278 (26.3%) 2 points, 260 (24.6%) 3 points, 209 (19.7%) 4 points, and 152 (14.3%) 5-6 points of ISAR scale. Ninety five (9.0%) patients died within 30 days. The percentage of mortality increased in relation to ISAR category (lineal trend P value <.001). The area under curve of ISAR scale was 0.703 (95%CI 0.655-0.751; P<.001). After adjusting for EFFECT risk categories, we observed a progressive increase in odds ratios of ISAR scale groups compared to reference (0-1 points).

Conclusions: scale is a brief and easy tool that should be considered for frailty screening during initial assessment of older patients attended with AHF for predicting 30-day mortality.

Keywords: Anciano; Emergency department; Fragilidad; Frailty; Identification of senior at risk; Mortalidad; Mortality; Older; Servicio de urgencias.