Frailty tied to poorer one-year survival among ICU patients after cardiac arrest: Study

The retrospective multicentre study, published in the Journal of Critical Care, revealed that frailty is associated with poorer one-year survival in patients admitted to Australian ICUs following an in-hospital cardiac arrest (IHCA).

"In critically ill adults who experienced IHCA, frail individuals faced significantly shorter median survival times (19 days versus 302 days) and worse overall one-year mortality than their non-frail counterparts (64.8% versus 36.4%)," the researchers reported. "Alarmingly, each unit increase in Clinical Frail Scale (CFS) associated with a 22% worse survival outcome, adjusted hazard ratio = 1.22."

In-hospital cardiac arrest is a serious medical emergency. When IHCA occurs in frail patients, short-term survival is poor. However, the effect of frailty on long-term survival is unknown. To fill this knowledge gap, Ryo Ueno, Intensive Care Medicine, Eastern Health, Victoria, Australia, and colleagues aimed to assess the association between frailty and one-year survival in IHCA patients admitted to ICU in Australia.

For this purpose, the researchers performed a retrospective multicentre study of all critically ill adult (age ≥ 16 years) patients admitted to Australian ICU between 2018 and 2022. It included all patients with an IHCA within the 24 hours before ICU admission with a documented Clinical Frail Scale (CFS).

The primary outcome was median survival up to one year after ICU admission. The effect of frailty on one-year survival was evaluated using a Cox proportional hazards model, adjusting for sex, age comorbidities, hospital type, and sequential organ failure assessment (SOFA) score.

The researchers reported the following findings:

• 3769 patients were examined, of whom 30.8% (n = 1160) were frail (CFS ≥ 5).
• The median survival was significantly shorter for patients with frailty (median days 19 versus 302).
• The overall one-year mortality was worse for the patients with frailty when compared to the non-frail group (64.8% versus 36.4%).
• Each unit increment in the CFS was associated with a 22% worse survival outcome (adjusted Hazard ratio = 1.22) after adjustment for confounders.
• The survival trend was similar among patients who survived the hospitalization.

"Early recognition of frailty may provide individualized patient-centered intervention for such patients with frailty admitted to ICUs and guide goals of care discussions," the researchers concluded.

Reference:

Ueno, R., Reddy, M. P., Jones, D., Pilcher, D., & Subramaniam, A. (2024). The impact of frailty on survival times up to one year among patients admitted to ICU with in-hospital cardiac arrest. Journal of Critical Care, 83, 154842. https://doi.org/10.1016/j.jcrc.2024.154842