Frailty is a key determinant of prognosis in older adults with complex chronic conditions and in palliative care settings. The Rockwood Frailty Index (RFI), based on the accumulation of health deficits, has demonstrated prognostic value across multiple clinical contexts. This study evaluates the association between the RFI and overall survival in complex chronic and palliative patients (oncologic and non-oncologic) treated in a Hospital-at-Home (HaH) unit.
This retrospective longitudinal observational cohort study included patients aged 65 years or older admitted to a Hospital-at-Home (HaH) unit between January 1, 2021 and December 31, 2024. All patients had a recorded modified Rockwood Frailty Index (RFI) at admission and were subsequently followed through a structured case-management program led by nurse case managers via scheduled telephone follow-up. Patients were classified into three clinical groups: complex chronic patients, non-oncologic palliative patients, and oncologic palliative patients. Non-oncologic palliative status was defined by an RFI ≥0.53, while complex chronic patients had an RFI \>0.37 and \<0.53. Oncologic palliative patients were classified based on referral from Oncology services regardless of frailty level. The primary outcome was overall survival, defined as time from discharge from the HaH unit to death from any cause. Survival analyses were conducted using Kaplan-Meier curves and multivariate Cox proportional hazards regression models adjusted for relevant demographic, clinical, and laboratory covariates.
Study Type
OBSERVATIONAL
Enrollment
2,610
Patients in this cohort received scheduled supportive telephone calls every two weeks if classified under palliative care (oncologic or chronic conditions), and once monthly if classified as chronic non-palliative patients.
Hospital Universitari i Politècnic La Fe
Valencia, Valencia, Spain
Overall Survival
Time from discharge from the Hospital-at-Home unit to death from any cause.
Time frame: 1 year
Comparative prognostic performance of the Rockwood Frailty Index versus Charlson Comorbidity Index
Comparison of the prognostic performance of the Rockwood Frailty Index and the Charlson Comorbidity Index for predicting overall survival. Measure: Hazard Ratios (HRs) for overall survival for each index. Unit of Measure: Hazard ratio Measurement Tool / Method: Rockwood Frailty Index; Charlson Comorbidity Index; Cox proportional hazards regression models.
Time frame: 1 year
Association between age and overall survival
Overall survival according to age at baseline. Measure: Hazard Ratio (HR) for overall survival per year increase in age Unit of Measure: Hazard ratio Measurement Tool / Method: Cox proportional hazards regression model
Time frame: 1 year
Association between sex and overall survival
Description: Overall survival according to sex at baseline. Measure: Hazard Ratio (HR) for overall survival comparing sex categories. Unit of Measure: Hazard ratio Measurement Tool / Method: Cox proportional hazards regression model
Time frame: 1 year
Association between overall survival and clinical variables (Charlson Comorbidity Index)
Overall survival according to Charlson Comorbidity Index at baseline. Measure: Hazard Ratio (HR) for overall survival per point increase in Charlson Comorbidity Index. Unit of Measure: Hazard ratio Measurement Tool / Method: Charlson Comorbidity Index; Cox proportional hazards regression model
Time frame: 1 year
Association between overall survival and clinical variables (Barthel Index)
Description: Overall survival according to the Barthel Index at baseline. Measure: Hazard Ratio (HR) for overall survival per point increase in Barthel Index. Unit of Measure: Hazard ratio Measurement Tool / Method: Barthel Index; Cox proportional hazards regression model
Time frame: 1 year
Association between overall survival and laboratory parameters (C-reactive protein)
Overall survival according to C-reactive protein levels at baseline. Measure: Hazard Ratio (HR) for overall survival per unit increase in C-reactive protein. Unit of Measure: Hazard ratio Measurement Tool / Method: Serum C-reactive protein concentration (mg/L); Cox proportional hazards regression model
Time frame: 1 year
Association between overall survival and laboratory parameters (albumin)
Description: Overall survival according to serum albumin levels at baseline. Measure: Hazard Ratio (HR) for overall survival per unit increase in serum albumin. Unit of Measure: Hazard ratio Measurement Tool / Method: Serum albumin concentration (g/dL); Cox proportional hazards regression model
Time frame: 1 year
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