# The hospital frailty risk score effectively predicts adverse outcomes in patients with atrial fibrillation in the intensive care unit

## TL;DR

This study shows that a hospital frailty risk score can predict poor outcomes in elderly patients with atrial fibrillation in the ICU.

## Contribution

This is the first study to evaluate the hospital frailty risk score in predicting adverse outcomes for older atrial fibrillation patients in the ICU.

## Key findings

- Frail patients had significantly higher in-hospital and 30-day mortality rates compared to non-frail patients.
- Frailty was found to be an independent risk factor for mortality in these ICU patients.
- Frail patients had a 1.56-fold increased risk of 30-day mortality after adjusting for confounding factors.

## Abstract

Atrial fibrillation (AF) and frailty are significant global public health problems associated with advancing age. However, the relationship between frailty and older patients with AF in the intensive care unit (ICU) has not been thoroughly investigated. This study aimed to investigate whether the hospital frailty risk score (HFRS) is associated with adverse outcomes in older patients with AF in the ICU.

This was the first retrospective analysis of older patients with AF admitted to the ICU between 2008 and 2019 at a tertiary academic medical center in Boston. The HFRS was used to measure frailty severity. The outcomes of interest were in-hospital and 30-day mortality and the incidence of sepsis and ischemic stroke.

There were 7,792 participants aged approximately 80 years, almost half (44.9%) of whom were female. Among this group, 2,876 individuals were identified as non-frail, while 4,916 were classified as frail. The analysis revealed a significantly greater incidence of in-hospital (18.8% compared to 7.6%) and 30-day mortality (24.5% versus 12.3%) in the frail group. After accounting for potential confounding factors, a multivariate Cox proportional hazards regression analysis revealed that frail participants had a 1.56-fold greater risk of mortality within 30 days (95% CI = 1.38–1.76, p < 0.001).

Frailty is an independent risk factor for adverse outcomes in older patients with AF admitted to the ICU. Therefore, prioritizing frailty assessment and implementing specific intervention strategies to improve prognostic outcomes are recommended.