Hospital frailty risk and CHA2DS2-VA scores in the mortality assessment of older patients with peripheral artery disease.

Abstract

Background: Older patients with peripheral artery disease (PAD) encounter an increased risk of in-hospital mortality. Accurate risk scoring methods are crucial for assessing the likelihood of cardiovascular events in these patients. However, a comprehensive comparison of these scoring methods for predicting in-hospital mortality in PAD patients has not yet been conducted. Patients and methods: This study analyzed 173,075 patients hospitalized with PAD in the year 2020 from a German nationwide registry. We assessed five risk scores: the Elixhauser Comorbidity Index, the Charlson Comorbidity Index, the CHA₂DS₂-VA Score, the EuroSCORE, and the Hospital Frailty Risk Score (HFRS). The average patient age was 72 ± 10.94 years, with 36.82% female and 35.27% also diagnosed with diabetes mellitus. The overall in-hospital mortality rate was 2.68%. Mean scores were 7.12±6.55 for the Elixhauser Comorbidity Index, 2.66±1.72 for the Charlson Comorbidity Index, 3.85±1.43 for the CHA₂DS₂-VA Score, 8.96%±8.85% for the EuroSCORE, and 3.53±5 for the HFRS. The HFRS showed the highest predictive potential for in-hospital mortality with an area under the curve (AUC) of 0.86 (95% confidence interval (CI): 0.86-0.87) but had the worst calibration for high-risk patients. The CHA₂DS₂-VA Score had the lowest AUC 0.69 (95% CI: 0.68-0.70) but was the most consistent prediction model regarding calibration. Conclusions: HFRS was the most effective overall predictor of in-hospital mortality, but did not detect those patients with a very high risk of mortality. The CHA₂DS₂-VA Score was the most robust predictor of increasing score points but had the lowest sensitivity. Therefore, use of the HFRS combined with application of the CHA₂DS₂-VA Score appears to be most appropriate in identifying older PAD patients at risk of in-hospital mortality.