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Purpose <p>To explore the association of frailty with mortality, functional outcome, and health status after out-of-hospital cardiac arrest.</p> Methods <p>This is a cohort-based secondary analysis of the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial, an international, prospective, multicentre study. Frailty was assessed using the Clinical Frailty Scale (1–9): fit (1–3), prefrail (4), frail (5), and severely frail (6–9). Main outcomes were mortality and poor functional outcome (modified Rankin Scale 4–6) at 6 and 24&#xa0;months. Additional outcomes included neuroprognostication, withdrawal-of-life-sustaining-therapies (WLST), functional decline (retrospectively reported pre-arrest versus 6&#xa0;month Glasgow Outcome Scale Extended score), health status (EQ-5D-5L, EQ-VAS), and life satisfaction at 6 and 24&#xa0;months.</p> Results <p>Of 1861 participants, 240 (13%) were prefrail, and 188 (10%) were frail or severely frail. Mortality and poor functional outcome increased significantly with greater frailty. Compared to fit participants, adjusted ORs (95% CI) for 6&#xa0;month mortality were: prefrail 2.7 (1.8–3.8), frail 3.7 (1.9–7.1), and severely frail 8.9 (4.2–18.7); and poor functional outcome: prefrail 2.9 (1.9–4.2), frail 3.9 (1.9–8.1), and severely frail 35.4 (8.4–148.8). Severely frail participants underwent neuroprognostication less often (<i>p</i> &lt; 0.001), while WLST was more common in the prefrail, frail and severely frail (<i>p</i> &lt; 0.001). Prefrail and frail survivors tended to report more frequent functional decline and lower health status, though with individual variation.</p> Conclusion <p>Frailty was associated with a significantly increased risk of mortality and poor functional outcome after out-of-hospital cardiac arrest. Findings suggest more frequent functional decline and lower overall health status in frail survivors.</p> Trial registration <p>NCT02908308.</p>

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Impact of frailty on mortality, functional outcome, and health status after out-of-hospital cardiac arrest: insights from the TTM2-trial

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  • 发表日期：

    2025年11月10日

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  • Sara Göbel Andertun,
  • Anne Wissendorff-Ekdahl,
  • Susann Ullén,
  • Tobias Cronberg,
  • Hans Friberg,
  • Janus Christian Jakobsen,
  • Erik Blennow Nordström,
  • Katarina Heimburg,
  • Alain Cariou,
  • Anders Morten Grejs,
  • Matthias Haenggi,
  • Jan Hovdenes,
  • Chiara Robba,
  • Christian Rylander,
  • Fabio Silvio Taccone,
  • Matt P. Wise,
  • Paul J. Young,
  • Niklas Nielsen,
  • Gisela Lilja

摘要

Purpose

To explore the association of frailty with mortality, functional outcome, and health status after out-of-hospital cardiac arrest.

Methods

This is a cohort-based secondary analysis of the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial, an international, prospective, multicentre study. Frailty was assessed using the Clinical Frailty Scale (1–9): fit (1–3), prefrail (4), frail (5), and severely frail (6–9). Main outcomes were mortality and poor functional outcome (modified Rankin Scale 4–6) at 6 and 24 months. Additional outcomes included neuroprognostication, withdrawal-of-life-sustaining-therapies (WLST), functional decline (retrospectively reported pre-arrest versus 6 month Glasgow Outcome Scale Extended score), health status (EQ-5D-5L, EQ-VAS), and life satisfaction at 6 and 24 months.

Results

Of 1861 participants, 240 (13%) were prefrail, and 188 (10%) were frail or severely frail. Mortality and poor functional outcome increased significantly with greater frailty. Compared to fit participants, adjusted ORs (95% CI) for 6 month mortality were: prefrail 2.7 (1.8–3.8), frail 3.7 (1.9–7.1), and severely frail 8.9 (4.2–18.7); and poor functional outcome: prefrail 2.9 (1.9–4.2), frail 3.9 (1.9–8.1), and severely frail 35.4 (8.4–148.8). Severely frail participants underwent neuroprognostication less often (p < 0.001), while WLST was more common in the prefrail, frail and severely frail (p < 0.001). Prefrail and frail survivors tended to report more frequent functional decline and lower health status, though with individual variation.

Conclusion

Frailty was associated with a significantly increased risk of mortality and poor functional outcome after out-of-hospital cardiac arrest. Findings suggest more frequent functional decline and lower overall health status in frail survivors.

Trial registration

NCT02908308.