(53) Prevalence, Characteristics, and Impacts of Frailty Measured by Multimorbidity Frailty Index Developed Using The ICD-9 CM and ICD-10 CM Codes Among Patients with Heart Failure in Taiwan: A Nationwide Cohort Study

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1098

Presenting Author(s)

Hsi-yu Lai
– National Taiwan University Graduate Institute of Clinical Pharmacy, Taipei, Taipei, Taiwan

Co-Author(s)

Shih-Tsung Huang, PharmD
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
Liang-Kung Chen
– Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan, Taipei, Taiwan, Taiwan (Republic of China)
Fei-Yuan Hsiao
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan (Republic of China)

Background: Frailty often coexists with heart failure (HF) and may has negative impacts on adverse outcomes among HF patients. How to quantify and characterize the impact of frailty on clinical outcomes among HF patients in an aging society is thus critical.

Objectives: In this study, we aimed to use the multimorbidity frailty index (mFI) developed using the ICD-9 CM and ICD-10 CM codes to estimate the prevalence of frailty and its impact on mortality and healthcare utilization among HF patients. The reason why we used mFI developed with different diagnostic codes is because Taiwan has adopted the ICD-10 CM codes since 2016. We thus would like to capture whether such change has any impact on quantification of frailty among HF patients in 2013 (ICD-9 era) and 2018 (ICD-10 era).

Methods: From Taiwan’s National Health Insurance Research Database (NHIRD), patients aged 40 years old and older who newly admitted for heart failure (index event) and discharged from the index event in 2013 (ICD-9 CM era) and 2018 (ICD-10 CM era) were identified. Frailty was measured by the mFI, a frailty index developed using ICD-9 CM (mFI-v9) and ICD-10 CM codes (mFI-v10), for HF patients identified in the year 2013 and 2018 cohorts All study subjects were further categorized into: fit, mild frailty, moderate frailty, and severe frailty based on the quartiles of mFI. Outcomes of interest (all-cause mortality, cause-specific mortality, outpatient visits, and emergency room (ER) visits) were reported. Cox regression models adjusted for sex and age were used to estimate the impacts of frailty on outcomes of interest.

Results: We identified 44,044 and 50,474 HF patients in the year 2013 and 2018, respectively. The proportion of frailty measured by mFI-v9 and mFI-v10 among HF patients were 72.5% in 2013 (mild 42.0%; moderate 24.8% and severe frailty 5.7%) and 78.3% (mild 50.0%; moderate 18.3% and severe frailty 10.0%) in 2018. Compared with the fit group, those with severe frailty were associated with a 1.2-fold (adjusted HR 1.24, 95% CI 1.15-1.35) higher risk for 1-year mortality in the 2013 HF cohort and 1.2-fold (adjusted HR 1.18, 95% CI 1.10-1.27) in the 2018 HF cohort, respectively. Cardiovascular diseases (exclude heart failure), neoplasm, pneumonia, heart failure, and diabetes mellitus are the top 5 causes of death in both cohorts.

Conclusions: Using the nationwide, claims-based NHIRD in Taiwan, our study reveals that the proportion of frailty measured by mFI increased in newly admitted HF patients as comparing the 2013 and 2018 HF cohorts. In addition, HF patients with frailty were associated with a higher mortality risk compared with the fit group. HF care programs adopting mFI for risk stratifications are therefore suggested.