Systematic Review of the Association of the Hospital Frailty Risk Score with Mortality in Patients with Cerebrovascular and Cardiovascular Disease.

BACKGROUND: There is limited systematic data on the association between the Hospital Frailty Risk Score (HFRS) and characteristics and mortality in patients with cerebrovascular and cardiovascular disease (CVD). This systematic review aimed to summarise the use of the HFRS in describing the prevalence of frailty in patients with CVD, the clinical characteristics of patients with CVD, and the association between frailty on the likelihood of mortality in patients with CVD. METHODS: A systematic literature search for observational studies using terms related to CVD, cerebrovascular disease, and the HFRS was conducted using 6 databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were appraised using the Newcastle-Ottawa Scale (NOS). RESULTS: Seventeen observational studies were included, all rated 'good' quality according to the NOS. One study investigated 5 different CVD cohorts (atrial fibrillation (AF), heart failure (HF), hypotension, hypertension, and chronic ischemic heart disease), 1 study investigated 2 different CVD cohorts (AF and acute myocardial infarction (AMI)), 6 studies investigated HF, 3 studies investigated AMI, 4 studies investigated stroke, 1 study investigated AF, and 1 study investigated cardiac arrest. Increasing frailty risk category was associated with increased age, female sex, and non-white racial group across all CVD. Increasing frailty risk category is also associated with increased length of hospital stay, total costs, and increased odds of 30-day all-cause mortality across all CVD. CONCLUSIONS: The HFRS is an efficient and effective tool for stratifying frailty in patients with CVD and predicting adverse health outcomes.

A cyst in the mist: bronchogenic mediastinal cysts.

Malformations of the bronchopulmonary foregut can lead to the formation of bronchogenic mediastinal cysts (BMC). BMC are rare congenital malformations usually found in the middle or posterior mediastinum. Only one-third of patients with BMC are symptomatic. We report a case of BMC in a 48-year-old female who was referred to the cardiothoracic surgeons due to an incidental finding of an anterior mediastinal mass on investigation for intermittent chest pain. The mass was treated surgically with a partial median sternotomy and mass excision. The patient's symptomology and mass histology were atypical for BMC. At follow-up, the patient reported no residual symptoms. This case demonstrates the significance of considering BMC, especially the anterior subtype, as a differential diagnosis in the findings of patients with intermittent chest pain and computerized tomography findings of a mediastinal mass.