Association Between Frailty, Use of Advanced Therapies, In-Hospital Outcomes, and 30-Day Readmission in Elderly Patients Admitted With Acute Pulmonary Embolism
Recommended Citation
Zghouzi M, Jabri A, Kumar S, Maligireddy A, Bista R, Paul TK, Nasser MF, Lichaa H, Aronow HD, Vallabhajosyula S, Kelly B, Grafton G, Awdish R, Basir MB, Alaswad K, Alqarqaz M, Koenig G, Aggarwal V. Association Between Frailty, Use of Advanced Therapies, In-Hospital Outcomes, and 30-Day Readmission in Elderly Patients Admitted With Acute Pulmonary Embolism. JACC Cardiovasc Interv 2025; 18(4).
Document Type
Conference Proceeding
Publication Date
6-16-2025
Publication Title
JACC Cardiovasc Interv
Abstract
Background: Clinical decision-making when assessing elderly patients with acute PE often involves an assessment of frailty that may impact the use of advanced therapies. We sought to evaluate the use of advanced therapies and associated in-hospital outcomes by frailty status in such patients. Methods: We utilized the National Readmission Database (NRD) to identify acute PE admissions in older patients ( > 75 years) from 2016 to 2020. We defined high-risk PE by the presence of one or more of the following: shock, progressive hypoxia, vasopressor use, or ECMO requirement. Frailty was determined using a previously validated hospital frailty risk score (HFRS). Results: Overall, 233,091 nationally representative patients with acute PE met the study inclusion criteria; 50.9% of patients with no frailty risk (score > 5), while 49.1% of patients with increased frailty risk (score 5-30). A total of 7.4% (17,277) of patients with high-risk features were identified, of whom 79.9% (13,810) patients were frail. Receipt of catheter-directed thrombolysis (CDT) and embolectomy (CDE) were comparable among high-risk frail and non-frail patients. Compared to non-frail patients, increased frailty was associated with higher in-hospital mortality. This increase was 2.3-fold in those without high-risk features and 1.2-fold in those with high-risk features. There is a similar increase in intracranial hemorrhage, gastrointestinal bleeding, and hematuria. Similarly, frailty and high-risk PE were associated with higher length of stay (LOS), increased resource utilization and cost, and fewer home discharges. Conclusion: Catheter-based therapies were utilized at similar rates in frail individuals compared to non-frail elderly individuals with high-risk PE. Increased frailty conferred an increased risk of in-hospital adverse events in elderly patients with PE.
Volume
18
Issue
4
