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Multicenter Study
. 2024 Jul;50(7):1064-1074.
doi: 10.1007/s00134-024-07404-9. Epub 2024 May 15.

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

John Muscedere  1 , Sean M Bagshaw  2 , Michelle Kho  3 , Sangeeta Mehta  4 , Deborah J Cook  5 , J Gordon Boyd  6 , Stephanie Sibley  7 , Han T Wang  8 , Patrick M Archambault  9   10 , Martin Albert  11 , Oleksa G Rewa  2 , Ian Ball  12 , Patrick A Norman  13 , Andrew G Day  13 , Miranda Hunt  7 , Osama Loubani  14 , Tina Mele  15 , Aimee J Sarti  16 , Jason Shahin  17 ; Canadian Critical Care Trials Group
Affiliations
Multicenter Study

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

John Muscedere et al. Intensive Care Med. 2024 Jul.

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.

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Conflict of interest statement

JM is the Scientific Director for the Canadian Frailty Network. SMB reports receiving fees for scientific advisory work from Baxter, BioPorto, Novartis, Sea Star Medical, Sphingotec (all unrelated to the submitted work). JGB receives a stipend from Ontario Health-Trillium Gift of Life for his role as Regional Medical Lead. He also received an in-kind contribution from Edwards Lifesciences who have provided cerebral oximeters for his program of research.

Figures

Fig. 1
Fig. 1
CONSORT diagram
Fig. 2
Fig. 2
Alluvial plot
Fig. 3
Fig. 3
Survival curves
Fig. 4
Fig. 4
Mortality by frailty severity
See this image and copyright information in PMC

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