Singh, Siddharth

ObjectiveThe objective of this study was to evaluate the association between frailty status and risk of readmissions, inpatient death, and cost of admission among patients with systemic lupus erythematosus (SLE).MethodsWe conducted a retrospective cohort study using the National Readmissions Database. Using International Statistical Classification of Diseases, Tenth Revision codes, we identified individuals >18 years of age who had a primary or secondary diagnosis of SLE and were hospitalized between January and June 2018. Using the validated claims‐based Hospital Frailty Risk Score, we categorized individuals as frail (score ≥ 5) or nonfrail (score < 5) at the time of index hospitalization. Our primary outcome was readmission rates post discharge from index hospitalization. Secondary outcomes were rates of inpatient mortality and the total cost of hospitalizations. Cox proportional hazard models were used to estimate the association between frailty and risk of readmissions, with adjustment for age, sex, insurance type, household income, and Elixhauser Comorbidity Index score.ResultsA total of 39,738 patients with SLE met eligibility criteria. Over a median follow‐up of eight months, frail patients with SLE (n = 18,385) had higher Elixhauser Comorbidity Index scores and longer length of stay compared to nonfrail patients with SLE (n = 21,353). Frail patients with SLE had higher readmission rates, a higher proportion of prolonged hospitalizations, and higher costs per hospitalization. Frailty was independently associated with a 10% higher risk of readmission after adjustment for covariates.ConclusionAmong hospitalized adults with SLE, presence of frailty was associated with higher readmission and inpatient mortality rates. Our results highlight that frailty status can help risk stratify patients with SLE at increased risk for readmissions and other adverse health outcomes.

Central obesity has been associated with adverse events in patients with cardiovascular disease (CVD). We undertook this study to evaluate predictors of overweight awareness, desire to lose weight and weight loss attempts in patients with CVD and central obesity. Association of physician-rendered diagnosis of overweight with weight loss attempts was also evaluated. Data from National Health and Nutrition Examination Survey (NHANES) 1999 –2004 were used. CVD was defined as self-referred history of coronary artery disease or stroke. Central obesity was determined based on a waist circumference > 102 cm in men and > 88 cm in women. Motivational factors considered as determinant for behavioral change that were evaluated included: participants’ awareness of their overweight status; desire to lose weight; any weight loss attempts in last year. We examined demographic, anthropometric and clinical determinants of each stage of change using multivariate models. Of the 1484 participants with CVD that were identified in NHANES, 824 had central obesity (56%). 76% of centrally obese participants were aware of their overweight status and 79% were desirous of losing weight. Despite this awareness and desire, only 41% of centrally obese had attempted weight loss in the last year. Only 61% reported that they had been informed that they were overweight by physicians. On multivariate analysis, after adjusting for sociodemographic factors and body mass index, physician rendered diagnosis of overweight was a significant predictor of weight loss attempts (OR=2.5, 95% CI 1.3– 4.9, p= 0.006). Awareness of one’s overweight status strongly predicted desire to lose weight in multivariate models (OR=107.6, 95 % CI 42.9 –270.0, p<.0001) and desire to lose weight was linked to recent attempts to lose weight (OR 10.4, 95 % CI 2.8– 39.2, p= 0.0005), confirming that the Transtheoretical Model of behavioral change applies to the study population. In a nationally representative sample of participants with CVD and central obesity, physician-rendered diagnosis of overweight emerged as an important predictor of weight loss attempts. Efforts to promote weight loss should focus on interventions based on Transtheoretical Model of behavioral change.

We investigated the burden of frailty across the spectrum of ankle-brachial index (ABI < 0.9, 0.9 ≤ ABI < 1.1, 1.1 ≤ ABI < 1.4 and ≥1.4) using data from the National Health and Nutritional Examination Survey (NHANES) in respondents aged >50 years. Criteria used to identify frailty status included weight loss, slow walking speed, weakness, exhaustion, and low physical activity. Participants meeting 1 to 2 criteria were classified as prefrail, and those meeting ≥3 criteria were classified as frail. Prevalence of frailty in respondents with ABI < 0.9 (17.5%) and 0.9 ≤ ABI < 1.1 (6.7%) was higher than in participants with normal ABI-1.1 ≤ ABI < 1.4 (4.7%). In multivariable multinomial logistic regression models, ABI < 0.9 predicted frailty (odds ratio [OR] = 2.31, 95% confidence interval [CI] = 1.08-4.94) and prefrailty (OR = 1.36, 95% CI = 0.90-2.07). Higher prevalence of frailty was seen in participants with ABI ≥ 1.4 (7.3%), P = .39. Frailty predicted general and cardiovascular mortality in participants with ABI < 0.9. Frailty mediates increased morbidity and mortality seen in peripheral arterial disease (PAD).