Abstract 18505: Cancer Therapy Induced Cardiotoxicity - A Look at Frailty

Abstract

Background: Malignancy and cardiovascular disease are leading causes of death in elderly adults. While assessments of functional status have long been used for decision-making regarding initiation of chemotherapy, less is known about the association between frailty and cardiotoxicity outcomes. Aims: To evaluate the association between claims-based frailty (using the Fried phenotypic definition) and heart failure and all-cause death in patients treated with anthracyclines. Hypothesis: An increased probability of frailty will be associated with an increased risk of heart failure after treatment with anthracyclines. Methods: We performed a single center retrospective analysis of Medicare Fee-for-Service beneficiaries (≥65 years) who received anthracycline chemotherapy. The Johns-Hopkins claims-based frailty index, based on the Fried frailty definition, was generated for all participants and divided into quartiles. Cox models, adjusted for the competing risk of death, were used to model time to heart failure hospitalization or death within 5 years of anthracycline receipt (both adjudicated on chart review). Results: A total of 312 patients (mean age 74 with range 65-94, 50% female) were included of which 35 (11.2%) individuals developed heart failure and 167 (54%) died over a median 476 (IQR 149.3-2074.5) days of follow-up. Increasing quartiles of frailty were not associated with heart failure (HR 1.77, 95% CI 0.51-6.21, p = 0.4 for highest frailty quartile), but were associated with death (HR 2.04, 95% CI 1.30-3.20, p = 0.002 for highest frailty quartile). However, the association with death was mitigated by adjustment for age, gender, coronary artery disease, hematopoietic stem cell transplant and leukemia (HR 1.91, 95% CI 0.93-3.97, p = 0.08 for highest frailty quartile). Conclusions: In this single center study at a large academic center, frailty was not associated with anthracycline-associated heart failure but identified individuals at higher risk of death. Future studies are needed to investigate frailty as a risk stratification tool.