• Sharry Kahlon, Jenelle Pederson, Sumit R Majumdar, Sara Belga, Darren Lau, Miriam Fradette, Debbie Boyko, Jeffrey A Bakal, Curtis Johnston, Raj S Padwal, and Finlay A McAlister.
• Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
• CMAJ. 2015 Aug 11;187(11):799-804.

BackgroundReadmissions after hospital discharge are common and costly, but prediction models are poor at identifying patients at high risk of readmission. We evaluated the impact of frailty on readmission or death within 30 days after discharge from general internal medicine wards.MethodsWe prospectively enrolled patients discharged from 7 medical wards at 2 teaching hospitals in Edmonton. Frailty was defined by means of the previously validated Clinical Frailty Scale. The primary outcome was the composite of readmission or death within 30 days after discharge.ResultsOf the 495 patients included in the study, 162 (33%) met the definition of frailty: 91 (18%) had mild, 60 (12%) had moderate, and 11 (2%) had severe frailty. Frail patients were older, had more comorbidities, lower quality of life, and higher LACE scores at discharge than those who were not frail. The composite of 30-day readmission or death was higher among frail than among nonfrail patients (39 [24.1%] v. 46 [13.8%]). Although frailty added additional prognostic information to predictive models that included age, sex and LACE score, only moderate to severe frailty (31.0% event rate) was an independent risk factor for readmission or death (adjusted odds ratio 2.19, 95% confidence interval 1.12-4.24).InterpretationFrailty was common and associated with a substantially increased risk of early readmission or death after discharge from medical wards. The Clinical Frailty Scale could be useful in identifying high-risk patients being discharged from general internal medicine wards.© 2015 Canadian Medical Association or its licensors.

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