Frailty in patients with saddle pulmonary embolus and acute cor pulmonale was associated with a higher 30-day readmission rate than non-frail patients (10.98% vs 5.88%; HR 1.664, 95% CI 1.421-1.949).
Observational (n=35,090)
Yes
Does frailty status impact outcomes, mortality, and early readmissions in patients with saddle pulmonary embolus and acute cor pulmonale?
Frailty in patients with saddle pulmonary embolus and acute cor pulmonale is associated with higher rates of adverse events during admission and a significantly increased risk of 30-day readmission.
Effect estimate: HR 1.664 (95% CI 1.421-1.949)
Absolute Event Rate: 10.98% vs 5.88%
p-value: p=<0.01
Abstract Introduction Saddle pulmonary embolus (SPE) can cause severe obstruction and acute cor pulmonale (ACP). Although prior research has linked frailty with outcomes following acute pulmonary embolism, its impact on patients with saddle pulmonary embolus with acute cor pulmonale (SPE-ACP) remains unclear. Methods We queried the Nationwide Readmissions Database (NRD) for SPE-ACP index admissions between 2016 and 2022, excluding patients who were younger than 18 years of age or COVID-19 positive. We used the Johns Hopkins Adjusted Clinical Groups frailty indicator (ACG) to stratify patients as frail or not. We reported patient demographics and explored complications during index admissions via multivariable regression analyses. We then estimated all-cause 30-day readmission rates and hazard ratio of readmissions using Cox-regression models. We conducted analyses via STATA 18.0, adjusting for the complex structure of the NRD. Results We yielded 35090 SPE-ACP index admissions, of which 5664 (16.14%) were frail. Frail patients were older, predominantly male, higher in Charlson Comorbidity Index (CCI) scores, and more often on Medicare. Other demographics are described in Table 1a. Frail patients had higher odds of adverse events, including cardiogenic shock, ECMO requirement, mechanical ventilation, vasopressor support, and others. We, however, noted that catheter-directed thrombolysis and systemic thrombolysis were less common among frail patients. We also noted that both groups had similar odds of acute myocardial infarction, cardiopulmonary resuscitation, hemorrhagic stroke, supraventricular tachycardia, and ventricular tachycardia. Although frail patients had a higher adjusted odds ratio of mortality, the difference was not statistically significant. Among survivors, frail patients had nearly double the readmission rate compared to non-frail (10.98% vs 5.88%), with a hazard ratio of 1.664 (95% CI: 1.421-1.949, p 0.01). Conclusions Our findings confirm that frailty significantly influences outcomes of patients with SPE-ACP, and is linked with higher resource utilization and readmissions. Frail patients were also less likely to receive aggressive thrombolytic interventions, possibly reflecting clinician risk-benefit assessments. These results highlight the need for individualized management strategies in this high-risk group. This abstract is funded by: None
Parto et al. (Fri,) conducted a observational in Saddle pulmonary embolus with acute cor pulmonale (n=35,090). Frailty vs. Non-frail was evaluated on All-cause 30-day readmission (HR 1.664, 95% CI 1.421-1.949, p=<0.01). Frailty in patients with saddle pulmonary embolus and acute cor pulmonale was associated with a higher 30-day readmission rate than non-frail patients (10.98% vs 5.88%; HR 1.664, 95% CI 1.421-1.949).