Background: Frailty is strongly associated with adverse health outcomes in older heart failure patients. Aims: We aimed to explore the effect of frailty on unplanned readmissions and death in chronic heart failure (CHF) patients aged 18 years or older. Methods: 342 chronic heart failure patients aged 18 years or older from heart centers of two tertiary care hospitals, located in north-west of China, were enrolled between July and December 2020. Frailty was assessed by the Tilburg Frailty Indicator. Patients were followed for unplanned readmissions, all-cause mortality at 30, 60, and 90 days after discharge. Multivariate cox regression models were used to analyze the effect of frailty on 90-day unplanned readmission and death in patients with CHF. Results: Frailty prevalence was 54.7% among 342 CHF patients, with a mean age of 64.65 ± 11.90 years. Compared to non-frailty CHF patients, the frailty CHF patients were older and had higher systolic blood pressure, longer duration of heart failure, more severe cognitive function, and more comorbidities ( P<0.05). Patients in the frail group had a higher incidence of unplanned readmission (73.1% vs. 26.9%, χ2 = 18.87, P < 0.01) and death (100% vs. 0%, χ2 = 6.94, P < 0.01) than those in the non-frail group. Multivariate cox regression analysis showed that frailty was an independent risk factor for 90-day unplanned readmission (HR = 1.469, 95% CI 1.318-1.637, P < 0.01) and 90-day death (HR=2.270, 95% CI 1.091-4.726, P<0.01) in patients with CHF. Discussion: Evaluation of frailty among CHF patients, include frailty in the routine evaluation of admission seems necessary to provide personalized intervention to improving their prognosis. Conclusion: Frailty is an independent predictor of unplanned readmission and death 90-day after discharge in CHF patients aged 18 years or older.

Objectives: This systematic review summarized and synthesized the available evidence to examines the cost-effectiveness of the implementation of Automated Medical Systems. Method: PubMed, Embase, Web of Science, The Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Full-text Database (VIP), WanFang Database, China Biopharmaceutical Scientific Literature Database (CBM) were searched from inception to February 2020. The reference lists of eligible studies were hand searched. After two investigators independently screened the literature and extracted the data, the quality of the included articles was evaluated by using the Cochrane Intervention Risk of Bias Assessment Tool, the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality Scale. Revman5.3 software was used for meta-analysis. Results: Sixteen articles (9 interventional studies, 6 cohort studies, 1 cross-sectional study) were finally included, 92,576 patients were included in analysis. Meta-analysis showed that: 1) compared with the traditional method, the incidence of adverse events (such as potential adverse drug reactions, deep vein thrombosis, etc.) was reduced after the implementation of the Automated Medical System (OR = 0.43, 95% CI = [0.20, 0.93]; P = 0.03); 2) the average medical costs incurred during the use of the Automated Medical System were lower than those of the traditional method (OR = 1.13, 95% CI = [1.02, 1.24]; P = 0.02), which was cost-effective (OR = 2.03, 95% CI = [1.34, 3.07]; P = 0.0008); 3) the quality-adjusted life years obtained by patients observed during the implementation of the Automated Medical System were significantly higher than those of the conventional medical system (OR = 1.13, 95% CI = [1.02, 1.24]; P = 0.02). Conclusion: A multicenter, large-sample randomized controlled trial is needed to comprehensively explore the cost-effectiveness of Automated Medical Systems using a unified economic evaluation model and considering all costs associated with Automated Medical Syst