Prognostic association of frailty with post-arrest outcomes following cardiac arrest: A systematic review and meta-analysis

Fabrice I Mowbray; Donna Manlongat; Rebecca H Correia; Ryan P Strum; Shannon M Fernando; Daniel McIsaac; Kerstin de Wit; Andrew Worster; Andrew P Costa; Lauren E Griffith; Matthew Douma; Jerry P Nolan; John Muscedere; Rachel Couban; Farid Foroutan

doi:10.1016/j.resuscitation.2021.06.009

Prognostic association of frailty with post-arrest outcomes following cardiac arrest: A systematic review and meta-analysis

Resuscitation. 2021 Oct:167:242-250. doi: 10.1016/j.resuscitation.2021.06.009. Epub 2021 Jun 21.

Authors

Affiliations

¹ Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada. Electronic address: mowbrayf@mcmaster.ca.
² College of Nursing, Wayne State University, 5557 Cass Ave, Detroit, MI 48202, USA. Electronic address: dmanlongat@wayne.edu.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada. Electronic address: correirh@mcmaster.ca.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada. Electronic address: strumr@mcmaster.ca.
⁵ Department of Emergency Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, Ontario K1H 8M5, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, Ontario K1H 8M5, Canada. Electronic address: sfernando@qmed.ca.
⁶ Department of Anesthesiology and Pain Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, Ontario K1H 8M5, Canada; The Ottawa Hospital School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Rm 101, Ottawa, Ontario, K1G 5Z3, Canada. Electronic address: dmcisaac@toh.ca.
⁷ Division of Emergency Medicine, Department of Medicine, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4L8, Canada. Electronic address: dewitk@mcmaster.ca.
⁸ Division of Emergency Medicine, Department of Medicine, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4L8, Canada. Electronic address: worstea@mcmaster.ca.
⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada; St. Joseph's Health System, 50 Charlton Ave. E, Hamilton, Ontario L8N 4A6, Canada. Electronic address: acosta@mcmaster.ca.
¹⁰ Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada; McMaster Institute for Research on Aging, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4L8, Canada. Electronic address: griffith@mcmaster.ca.
¹¹ Department of Critical Care Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta T6G 2R3, Canada. Electronic address: douma@ualberta.ca.
¹² Resuscitation Medicine, Warwick Medical School, University of Warwick, Medical School Building, Coventry CV4 7HL, United Kingdom; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, United Kingdom. Electronic address: jerrynolan@me.com.
¹³ Department of Critical Care Medicine, Queen's University, 99 University Ave, Kingston, Ontario K7L 3N6, Canada. Electronic address: john.muscedere@kingstonhsc.ca.
¹⁴ Department of Anesthesia, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4L8, Canada. Electronic address: rcouban@mcmaster.ca.
¹⁵ Ted Rogers Centre for Heart Research, University Health Network, 661 University Ave, Toronto, Ontario M5G 1X8, Canada. Electronic address: farid.foroutan@uhn.ca.

PMID: 34166743
DOI: 10.1016/j.resuscitation.2021.06.009

Abstract

Objective: To synthesize the current evidence examining the association between frailty and a series of post-arrest outcomes following the provision of cardiopulmonary resuscitation (CPR).

Data sources: We searched MEDLINE, PubMed (exclusive of MEDLINE), EMBASE, CINAHL, and Web of Science from inception to August 2020 for observational studies that examined an association between frailty and post-arrest health outcomes, including in-hospital and post-discharge mortality. We conducted citation tracking for all eligible studies.

Study selection: Our search yielded 20,480 citations after removing duplicate records. We screened titles, abstracts and full-texts independently and in duplicate.

Data extraction: The prognosis research strategy group (PROGRESS) and the critical appraisal and data extraction for systematic review of prediction modelling studies (CHARMS) guidelines were followed. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) instrument. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) recommendations for prognostic factor research.

Data synthesis: Four studies were included in this review and three were eligible for statistical pooling. Our sample comprised 1,134 persons who experienced in-hospital cardiac arrest (IHCA). The mean age of the sample was 71 years. The study results were pooled according to the specific frailty instrument. Three studies used the Clinical Frailty Scale (CFS) and adjusted age (our minimum confounder); the presence of frailty was associated with an approximate three-fold increase in the odds of dying in-hospital after IHCA (aOR = 2.93; 95% CI = 2.43-3.53, high certainty). Frailty was also associated with decreased incidence of ROSC (return of spontaneous circulation) and discharge home following IHCA. One study with high risk of bias used the Hospital Frailty Risk Score and reported a 43% decrease in the odds of discharge home for patients with frailty following IHCA.

Conclusion: High certainty evidence was found for an association between frailty and in-hospital mortality following IHCA. Frailty is a robust prognostic factor that contributes valuable information and can inform shared-decision making and policies surrounding advance care directives. Registration: PROSPERO Registration # CRD42020212922.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Frailty; Prognosis.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Aftercare
Aged
Cardiopulmonary Resuscitation*
Frailty*
Heart Arrest* / therapy
Humans
Patient Discharge
Prognosis