Do frailty screening tools assessed at emergency department presentation predict in-hospital mortality and length of stay in older adults with acute pulmonary edema?: A prospective cohort study

İngilizce (OpenAlex)

Frailty is common in older adults with acute heart failure, yet whether bedside frailty instruments assessed during acute physiological decompensation can predict short-term hospital outcomes remain uncertain. This study examined the association between frailty, measured at emergency department presentation, and in-hospital mortality and length of stay in older patients hospitalized with acute pulmonary edema. A prospective cohort study was conducted at a tertiary emergency department between January 15 and September 15, 2025. Consecutive adults aged ≥ 65 years who presented with acute pulmonary edema and required hospitalization were enrolled. Frailty was assessed at the time of emergency department presentation using the Clinical Frailty Scale (CFS), Programme de Recherche sur l'Intégration des Services de Maintien de l'Autonomie-7 (PRISMA-7), and the Tilburg frailty indicator (TFI). Primary outcomes were in-hospital mortality and prolonged hospitalization, defined as a length of stay exceeding the 75th percentile of the cohort's distribution (>12 days). Multivariable logistic regression and receiver operating characteristic analysis were used. Among 253 participants, frailty prevalence was high across instruments (71-73%). Median hospital length of stay was 8 days (interquartile range 5-12), and in-hospital mortality was 6.7% (n = 17). In adjusted analyses, none of the frailty instruments were independently associated with in-hospital mortality or prolonged hospitalization. For mortality, no baseline variable reached statistical significance; CRP showed a trend (OR 1.01; 95% CI: 1.00-1.01; P = .073). The history of coronary artery disease was independently associated with lower odds of prolonged hospitalization (OR 0.52; 95% CI: 0.28-0.98; P = .042). All frailty instruments showed poor discrimination for both outcomes, with AUC values ranging from 0.51 to 0.62 and confidence intervals that included 0.50. Older patients hospitalized with acute pulmonary edema had a high prevalence of frailty, yet frailty instruments assessed at emergency department presentations showed limited ability to predict short-term in-hospital outcomes. Frailty scoring performed during an acute decompensation episode may not reliably reflect baseline vulnerability; its role in this setting may be better suited to care planning and post-discharge risk stratification than to short-term prognostication.