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Methods

Study Design

This was a retrospective cohort study that used national Veterans Health Administration (VA) data. Veterans aged≥ 50 years with an index hospital admission for HF from 2016 to 2019 were included. We excluded veterans with< 2 primary care visits in the 3 years before their date of admission to indicate regular use of VA care. We included those with documentation of ejection fraction. We used the validated VA FI, which captures 31 deficits in health based on International Classification of Diseases, Tenth Revision, and Current Procedural Terminology codes [6]. We estimated the FI for each preceding year, without overlap. We fit a linear line to 3 calculated FIs for each year prior to the index date of admission and reported the slope and intercept individually. This method provided a 3-year longitudinal estimate of frailty at admission. We used 1-year all-cause mortality following the index date of admission as the primary outcome. We reported the area under the curve (AUC) for predicting outcomes, using logistic regression. We estimated two AUCs:(1) FI at the time of admission (AUC FI) and (2) FI at time of admission plus slope and intercept (AUC frailty trajectory (FT)+ FI). Changes in the AUCs were reported as the percentage of improvement (Δ AUC= 100%×[AUC FT+ FI–AUC FI]/AUC FI). We recursively calculated the AUCs and Δ AUC by including patients whose FIs at admission were< 0.1 and, at each step, increased the FI level by 0.01 to 0.4.