P3750Frailty index and long-term outcomes following hospitalization with acute decompensated heart failure

Abstract

Background: The Norton scale scoring system is commonly used to assess the frailty of hospitalized patients. We hypothesized that a low Norton score is an independent predictor of long-term mortality among hospitalized acute heart failure (AHF) patients. Methods: The study population comprised 4388 AHF patients presenting to large tertiary medical center between the years 2008-2016 who were prospectively followed-up for long-term mortality and HF hospitalization. Multivariate Cox proportional hazards regression modeling was used to assess the independent association between Norton score (dichotomized as <16 [low] vs. ≥16 [high]) and long-term mortality. Results: Patients with a low score (n=1611 [37%]) were older, had higher prevalence of co-morbidities such as hypertension, COPD, anemia, CVA and renal failure (p<0.05 for all). Kaplan-Meier survival analysis showed that at 1-year of follow-up mortality rates were significantly higher among patients with a low Norton score (34%) as compared with those with a high score (15%; p<0.001 for the overall difference during follow-up). Consistently, multivariate analysis showed that a low Norton score was independently associated with >2-fold increased risk of all-cause mortality at 1 and 5 years following the index hospitalization (p<0.001 for both). The association between Norton and mortality was consistent in both the HFrEF and HFpEF subgroups (p-value for interaction <0.10). (Figure presented) Conclusion: Our findings, from a large cohort of hospitalized heart failure patients, show that the Norton score at admission is a powerful independent predictor of long-term mortality. These data suggest that the scale should be added as an important risk stratification parameter in this high-risk population.