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Heckman GA, Barnard K, McKelvie RS. Yes, Frailty Matters: Time for Action. Can J Cardiol 2024; 40:685-687. [PMID: 38181973 DOI: 10.1016/j.cjca.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/31/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024] Open
Affiliation(s)
- George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Kari Barnard
- St. Joseph's Health Care London and Western University, London, Ontario, Canada
| | - Robert S McKelvie
- St. Joseph's Health Care London and Western University, London, Ontario, Canada
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Dash D, Mowbray FI, Poss JW, Aryal K, Stall NM, Hirdes JP, Hillmer MP, Heckman GA, Bowdish DME, Costa AP, Jones A. The association between frailty, long-term care home characteristics and COVID-19 mortality before and after SARS-CoV-2 vaccination: a retrospective cohort study. Age Ageing 2023; 52:afad229. [PMID: 38163287 DOI: 10.1093/ageing/afad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/19/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The relative contributions of long-term care (LTC) resident frailty and home-level characteristics on COVID-19 mortality has not been well studied. We examined the association between resident frailty and home-level characteristics with 30-day COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination in LTC. METHODS We conducted a population-based retrospective cohort study of LTC residents with confirmed SARS-CoV-2 infection in Ontario, Canada. We used multi-level multivariable logistic regression to examine associations between 30-day COVID-19 mortality, the Hubbard Frailty Index (FI), and resident and home-level characteristics. We compared explanatory models before and after vaccine availability. RESULTS There were 11,179 and 3,655 COVID-19 cases in the pre- and post-vaccine period, respectively. The 30-day COVID-19 mortality was 25.9 and 20.0% during the same periods. The median odds ratios for 30-day COVID-19 mortality between LTC homes were 1.50 (95% credible interval [CrI]: 1.41-1.65) and 1.62 (95% CrI: 1.46-1.96), respectively. In the pre-vaccine period, 30-day COVID-19 mortality was higher for males and those of greater age. For every 0.1 increase in the Hubbard FI, the odds of death were 1.49 (95% CI: 1.42-1.56) times higher. The association between frailty and mortality remained consistent in the post-vaccine period, but sex and age were partly attenuated. Despite the substantial home-level variation, no home-level characteristic examined was significantly associated with 30-day COVID-19 mortality during either period. INTERPRETATION Frailty is consistently associated with COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination. Home-level characteristics previously attributed to COVID-19 outcomes do not explain significant home-to-home variation in COVID-19 mortality.
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Affiliation(s)
- Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Fabrice I Mowbray
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Komal Aryal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathan M Stall
- Division of General Internal Medicine and Geriatrics, Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Michael P Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Dawn M E Bowdish
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph's Health Care Hamilton, Hamilton, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Turcotte LA, Heckman G, Rockwood K, Vetrano DL, Hébert P, McIsaac DI, Rhynold E, Mitchell L, Mowbray FI, Larsen RT, Hirdes JP. External validation of the hospital frailty risk score among hospitalised home care clients in Canada: a retrospective cohort study. Age Ageing 2023; 52:7024514. [PMID: 36735847 PMCID: PMC9897298 DOI: 10.1093/ageing/afac334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Hospital Frailty Risk Score (HFRS) is scored using ICD-10 diagnostic codes in administrative hospital records. Home care clients in Canada are routinely assessed with Resident Assessment Instrument-Home Care (RAI-HC) which can calculate the Clinical Frailty Scale (CFS) and the Frailty Index (FI). OBJECTIVE Measure the correlation between the HFRS, CFS and FI and compare prognostic utility for frailty-related outcomes. DESIGN Retrospective cohort study. SETTING Alberta, British Columbia and Ontario, Canada. SUBJECTS Home care clients aged 65+ admitted to hospital within 180 days (median 65 days) of a RAI-HC assessment (n = 167,316). METHODS Correlation between the HFRS, CFS and FI was measured using the Spearman correlation coefficient. Prognostic utility of each measure was assessed by comparing measures of association, discrimination and calibration for mortality (30 days), prolonged hospital stay (10+ days), unplanned hospital readmission (30 days) and long-term care admission (1 year). RESULTS The HFRS was weakly correlated with the FI (ρ 0.21) and CFS (ρ 0.28). Unlike the FI and CFS, the HFRS was unable to discriminate for 30-day mortality (area under the receiver operator characteristic curve (AUC) 0.506; confidence interval (CI) 0.502-0.511). It was the only measure that could discriminate for prolonged hospital stay (AUC 0.666; CI 0.661-0.673). The HFRS operated like the FI and CFI when predicting unplanned readmission (AUC 0.530 CI 0.526-0.536) and long-term care admission (AUC 0.600; CI 0.593-0.606). CONCLUSIONS The HFRS identifies a different subset of older adult home care clients as frail than the CFS and FI. It has prognostic utility for several frailty-related outcomes in this population, except short-term mortality.
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Affiliation(s)
- Luke Andrew Turcotte
- Address correspondence to: Luke Andrew Turcotte, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University and Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden, & Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Paul Hébert
- Université de Montréal et Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Daniel I McIsaac
- Departments of Anesthesiology & Pain Medicine, University of Ottawa, and The Ottawa Hospital; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth Rhynold
- Section of Geriatric Medicine, University of Manitoba and Prairie Mountain Health, Manitoba, Canada
| | - Lori Mitchell
- Home Care Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Fabrice Immanuel Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rasmus T Larsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Copenhagen, Denmark
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Heckman GA, Rockwood K. Frailty, Risk, and Heart Failure Care: Commission or Omission? J Am Coll Cardiol 2022; 80:1144-1146. [PMID: 36050228 DOI: 10.1016/j.jacc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022]
Affiliation(s)
- George A Heckman
- Schlegel Research Chair in Geriatric Medicine, Research Institute for Aging, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Kenneth Rockwood
- Faculty of Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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