Prevalence Of Frailty In Patients Research Articles

Research Progress on Cognitive Frailty in Older Adults with Chronic Kidney Disease.

As the medical challenges posed by the ageing population become increasingly severe, the proportion of older people among patients with chronic kidney disease (CKD) is increasing every year. The prevalence of frailty in patients with CKD is significantly higher than that in the general population, and older patients are also a high-risk group for frailty and cognitive impairment. Cognitive frailty, as an important subtype of frailty, is a syndrome characterised by cognitive dysfunction caused by physiological factors, excluding Alzheimer's disease and other types of dementia. It is characterised by the coexistence of physical frailty and cognitive impairment. Previous studies have mainly focused on cognitive impairment, and there is limited research on cognitive frailty, particularly in older patients with CKD. This article provides a comprehensive review of the concept, epidemiology, screening methods, prevention, and treatment measures and possible pathogenesis of cognitive frailty in patients with CKD.

Developing and validating machine learning-based prediction models for frailty occurrence in those with chronic obstructive pulmonary disease.

Frailty is a medical syndrome caused by multiple factors, characterized by decreased strength, endurance, and diminished physiological function, resulting in increased susceptibility to dependence and/or death. Patients with chronic obstructive pulmonary disease (COPD) tend to be more vulnerable to frailty due to their physical and psychological burdens. Therefore, the aim of this study was to develop a reliable and accurate vulnerability risk prediction model for frailty in patients with COPD in order to improve the identification and prediction of patient frailty. The specific objectives of this study were to determine the prevalence of frailty in patients with COPD and develop a prediction model and evaluate its predictive power. Clinical information was analyzed using data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database, and 34 indicators, including behavioral factors, health status, mental health parameters, and various sociodemographic variables, were examined in the study. The adaptive synthetic sampling technique was used for unbalanced data. Three methods, ridge regressor, extreme gradient boosting (XGBoost) classifier, and random forest (RF) regressor, were used to filter predictors. Seven machine learning (ML) techniques including logistic regression (LR), support vector machines (SVM), multilayer perceptron, light gradient-boosting machine, XGBoost, RF, and K-nearest neighbors were used to analyze and determine the optimal model. For customized risk assessment, an online predictive risk modeling website was created, along with Shapley additive explanation (SHAP) interpretations. Depression, smoking, gender, social activities, dyslipidemia, asthma, and residence type (urban vs. rural) were predictors for the development of frailty in patients with COPD. In the test set, the XGBoost model had an area under the curve of 0.942 (95% confidence interval: 0.925-0.959), an accuracy of 0.915, a sensitivity of 0.873, and a specificity of 0.911, indicating that it was the best model. The ML predictive model developed in this study is a useful and easy-to-use instrument for assessing the vulnerability risk of patients with COPD and may aid clinical physicians in screening high-risk patients.

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

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. 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). 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. The HFRS is an efficient and effective tool for stratifying frailty in patients with CVD and predicting adverse health outcomes.

Prevalence of Frailty and Its Impact on Mortality and Hospitalization in Patients With Cirrhosis: A Systematic Review and Meta-analysis

Background & AimsFrailty in patients with cirrhosis is associated with increased morbidity and mortality. In this study, we aimed to determine the prevalence of frailty and its impact on mortality and hospitalization in patients with cirrhosis. MethodsAn elaborate search was undertaken in the following databases: "PubMed, Scopus, Web of Science, Cochrane, and preprint servers”, and an assessment of all published articles till 17 February 2023 was done. Studies that provided data on prevalence, mortality and hospitalization, among frail patients with cirrhosis were included. The study characteristics and data on the prevalence, mortality, and hospitalization were extracted from included studies. The primary outcome was to estimate the pooled prevalence of frailty and determine its impact on mortality and hospitilization in patients with cirrhosis. ResultsOverall, 12 studies were included. Data on prevalence of frailty and mortality was available in 11 studies while seven studies reported data on hospitalization. The analysis conducted amongst 6126 patients with cirrhosis revealed pooled prevalence of frailty to be 32% (95% confidence interval [CI] 24-41). A total of 540 events of death revealed pooled mortality rate of 29% (95% CI, 19-41). Six months and twelve months pooled estimates of mortality were found to be 24% (95% CI, 17-33) and 33% (95% CI, 23-45) respectively. The pooled hospitalization rate among the seven studies was 43% (95% CI, 21-68). ConclusionsThe prevalence of frailty in patients with cirrhosis is high leading to poor outcomes. Frailty assessment should become an integral part of cirrhosis evaluation. Registry and registration number of studyPROSPERO 2022 CRD42022377507.

PREVALENCE OF PRE-FRAILTY AND FRAILTY IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE

Highlights The article is focused on one of the most urgent modern issues – the peculiarities of the diagnosis of pathological aging. Due to the absence of a “gold standard” of detection of frailty, attempts to assess its prevalence among the population of different age groups present fragmented and controversial data. In this study, for the first time, the prevalence of frailty in patients with multivessel coronary artery disease, characterized by extremely pronounced clinical complexity, was analyzed using six different diagnostic approaches, allowing us to obtain data on the sensitivity and specificity of these instruments. AbstractAim. To study the prevalence of pre-frailty and frailty in patients with multivessel coronary artery disease.Methods. The study included 387 patients with multivessel coronary artery disease scheduled for coronary artery bypass grafting. To detect pre-frailty and frailty, we have used various diagnostic approaches, such as the screening questionnaire “Age is not a drawback”, a multi-stage diagnostic framework based on the clinical recommendations on frailty developed by the “Russian Association of Gerontologists and Geriatricians” in 2020, the questionnaire “PRISMA-7”, the clinical frailty scale, the criteria of the Fried frailty phenotype, and the modified 5-item frailty index (mFI-5).Results. The median age was 65 [59; 69] years, men were the majority (73.1%). Taking into account six diagnostic approaches, the prevalence of frailty in patients with multivessel coronary artery disease varied from 19.1% to 71.6%, the prevalence of pre-frailty varied from 15% to 58.2%. A high number of patients with frailty was detected using a multi-stage diagnostic framework based on the on the clinical recommendations on frailty developed by the “Russian Association of Gerontologists and Geriatricians” (46.8%), the clinical frailty scale (44.5%), the criteria of the Fried frailty phenotype (42.4%) and mFI-5 (71.6%), the lowest number of patients with frailty was detected using the questionnaire “PRISMA-7” (22.5%). The clinical frailty scale showed a higher level of sensitivity and specificity (67.8% and 80%, respectively) regarding the detection of pre-frailty, whereas a multi-stage diagnostic framework had a higher level of sensitivity and specificity (65.2% and 76.8%, respectively) regarding the detection of frailty.Conclusions. The results of the study revealed a high prevalence of pre-frailty (15–58.2%) and frailty (19.1–71.6%) in patients with multivessel coronary artery disease, taking into account several diagnostic approaches. The clinical frailty scale and a multi-stage diagnostic framework based on the recommendations showed the highest sensitivity and specificity regarding the detection of frailty (clinical frailty scale – 67.8% and 80%, respectively; a multi-stage diagnostic framework – 65.2% and 76.8%, respectively).

Prevalence and Impact of Frailty in Pancreatic Cancer: A Systematic Review and Meta-Analysis Based on 35,191 Patients.

Frailty has been associated with increased mortality among patients with pancreatic cancer. Nevertheless, several lines of evidence regarding the prevalence of frailty in patients with pancreatic cancer and mortality in patients with pancreatic cancer and frailty have not been thoroughly investigated and require clarification. A systematic review and meta-analysis of studies indexed in PubMed, Scopus, Web of Science, and Embase through March 2023 were conducted, and the pooled prevalence and relative risk (RR) estimate were calculated. A total of 18 studies containing 35,191 patients with pancreatic cancer were included. The prevalence of frailty in pancreatic cancer was 45% (95% CI = 29-62; I2 = 99.9%; p = 0.000). In patients with pancreatic cancer, frailty was associated with increased relative risk for mortality (RR = 1.70; 95% CI = 1.30-2.22; I2 = 84.8%, p = 0.000). Frailty prevalence in pancreatic cancer is common and exerts a significant negative impact on the survival of patients with pancreatic cancer. Our findings are characterized by significant heterogeneity, and caution is warranted in their interpretation. However, these findings highlight the importance of evaluating frailty, which may provide prognostic data and inform decision-making priorities.

Frailty in Patients With Chronic Kidney Disease Stage Five.

Aim To study the prevalence of frailty in patients with chronic kidney disease stage 5 (CKD5) and to assess coexisting factors associated with frailty in chronic kidney disease. Patients and methods We studied the prevalence of frailty in CKD5 patients from November 2021 to November 2022. CKD5 patients over 18 years of age were included. Patients on maintenance hemodialysis and CKD5 patients on pre-dialysis care were included. Patients with active infection and significant morbidity were excluded. We performed a history and clinical examination and recorded laboratory data. We performed frailty assessments using modified Fried's criteria. Frailty was defined based on previously validated Fried's criteria, which included 1. Slowness, 2. Weakness, 3. Unintentional weight loss, 4. Exhaustion, 5. Low physical activity. A patient is considered frail if three or more components are present. We evaluated the prevalence of frailty in pre-dialysis and dialysis care participants and the association of frailty with coexisting factors. Results Of the 139 patients, 84 were on thrice-weekly hemodialysis, and 55 were on pre-dialysis care. We found the prevalence of frailty to be 41%. The prevalence of frailty was similar in patients on pre-dialysis care and hemodialysis. The prevalence of frailty in hemodialysis patients and those in pre-dialysis care was 43% and 40%, respectively. The prevalence of frailty among the elderly (over 55) was 82%. The prevalence of frailty among diabetes patients was 75%. Factors with a statistically significant association with frailty included old age (p< 0.005), native kidney disease (p < 0.005), edema (p < 0.001), intradialytic hypotension (p = 0.002), and various comorbidities like diabetes (p < 0.001), heart failure (p < 0.001), coronary artery disease (p = 0.001), and cerebrovascular accidents (p = 0.016). We observed no significant association with the duration of chronic kidney disease (CKD) (p = 0.458), duration of dialysis (p = 0.838), or body mass index (BMI) (p = 0.267). The most commonly reported frailty components were exhaustion (61.9%), low physical activity (61.2%), and weak handgrip (55.4%). Conclusion Frailty is a marker of increased vulnerability to adverse outcomes. A significant proportion, 41% of CKD5 patients, are frail. Dialysis does not affect the prevalence of frailty in CKD5 patients. Old age, native kidney disease, edema, intradialytic hypotension, and comorbidities like diabetes, heart failure, coronary artery disease, and cerebrovascular accident are significantly associated with frailty in CKD5 patients. CKD patients with those conditions should receive special care to reduce the development of frailty.

High prevalence of frailty in patients with lower urinary tract symptoms.

Older adults are more likely to be frail and have a high prevalence of urological diseases such as lower urinary tract symptoms (LUTS). The purpose of this study was to clarify the prevalence and characteristics of comorbid frailty in older patients with urological diseases. We retrospectively reviewed the medical records of 970 patient who visited the Department of Urology, Juntendo University Hospital between October 2015 and October 2016. Patients were selected who were 65 years of age or older and were being evaluated by the Kihon Checklist (KCL) to assess frailty. We examined the prevalence of comorbid frailty in urological diseases, identified factors associated with comorbid frailty in urological diseases, and examined KCL scores in urological diseases with a high prevalence of frailty. A total of 405 participants were included. Of these, 21.7% were frail, 20.5% were pre-frail, and 57.8% were robust. LUTS, overactive bladder, and neurogenic bladder showed a statistically significant relationship with comorbid frailty, with high frailty prevalence rates of 44/140 (31.4%), 19/36 (52.8%), and 4/6 (66.7%), respectively. Factors related to the comorbid frailty according to multivariate analysis were female sex (P = 0.001), older age (P < 0.001), and LUTS (P < 0.033). Of the KCL subscale scores, instrumental activities of daily living (P = 0.008), physical function (P < 0.001), oral function (P = 0.008), housebound (P = 0.009), and depression (P = 0.034) were higher in LUTS patients than in non-LUTS patients. Among patients with urological diseases, those with LUTS were found to have a high prevalence of frailty. Geriatr Gerontol Int 2023; 23: 609-615.

Comparison of Two Frailty Assessment Methods and Their Association with Functionality in Subjects with Exacerbation of COPD.

To verify the prevalence of frailty in patients hospitalized with acute exacerbation of COPD; to compare two frailty assessment methods: Edmonton Scale and the Fried Frailty Phenotype, and to associate frailty with functioning in these patients. Patients hospitalized due to an acute exacerbation of COPD were included. The assessment of pulmonary function, frailty, and functioning was performed. Frailty assessment was performed by the Edmonton Scale and Fried Frailty Phenotype. Individuals were classified into "frail," "pre-frail" and "non-frail." Functioning was evaluated by the one sit-to-stand test. Thirty-five individuals were included (17 male, 69 ± 9 years; FEV1/FVC 47 ± 10%; FEV1 34 (24-52) % predicted). Participants scored 3 (3-4) points on the Edmonton Scale and 7 (5-9) points on the Fried Frailty Phenotype. According to the Fried model, 17% were considered prefrail and 83% frail and in the Edmonton scale, 20% were classified as nonfrail, 29% prefrail, and 51% frail. There was a positive moderate correlation between the two methods (r = 0.42; p=0.011); however, there was no agreement between them (p=0.20). This probably occurs because they assess the same construct, i.e., frailty; however, they are different in their components. There was a negative and moderate correlation between the Fried Frailty Phenotype and functioning (r = -0.43; p=0.009). Most hospitalized individuals with exacerbated COPD with severe and very severe airflow limitation are frail and the assessment methods correlate, but there is no agreement. Additionally, there is association between frailty and functioning in this population.

Prevalence of Frailty in Patients with Hepatocellular Carcinoma: A real-world observational Study

Prevalence of Frailty in Patients with Hepatocellular Carcinoma: A real-world observational Study

Prevalence of frailty among patients with inflammatory bowel disease and its association with clinical outcomes: a systematic review and meta-analysis

BackgroundStudies have reported frailty as an independent risk factor of mortality in patients with inflammatory bowel disease (IBD). However, no systematic review and meta-analysis has been conducted to determine the relationship of frailty and IBD. We aimed to investigate the prevalence of frailty in patients with IBD and the impact of frailty on the clinical prognosis of these patients.MethodsWe systematically searched PubMed, Ovid (Medline), Embase, Web of Science, and Cochrane Library from database inception until October 2022. This systematic review included observational studies describing IBD and frailty. We performed meta-analysis for the frailty prevalence in patients with IBD. We analyzed primary outcomes (mortality) and secondary outcomes (infections, hospitalizations, readmission, and IBD-related surgery).ResultsNine studies with a total of 1,495,695 participants were included in our meta-analysis. The prevalence of frailty was 18% in patients with IBD. The combined effect analysis showed that frail patients with IBD had a higher risk of mortality (adjusted hazard ratio = 2.25, 95% confidence interval: 1.11–4.55) than non-frail patients with IBD. The hazard ratio for infections (HR = 1.23, 0.94–1.60), hospitalizations (HR = 1.72, 0.88–3.36), readmission (HR = 1.21, 1.17–1.25) and IBD-related surgery (HR = 0.78, 0.66–0.91) in frail patients with IBD.ConclusionsWe demonstrated that frailty is a significant independent predictor of mortality in patients with IBD. Our work supports the importance of implementing frailty screening upon admission in patients with IBD. More prospective studies are needed to investigate the influence of frailty on patients with IBD and improve the poor prognosis of patients with frailty and IBD.

Prevalence of frailty in patients with lower extremity peripheral arterial disease: A systematic review and meta-analysis.

Increasing studies have reported on the prevalence of frailty in patients with peripheral artery disease (PAD). The aim of this systematic review and meta-analysis was to estimate the pooled prevalence of frailty in patients with lower extremity PAD. Two authors systematically searched PubMed and Embase databases from their inception to August 8, 2022. Original articles that reported the prevalence of frailty in patients with lower extremity PAD were included. The prevalence of frailty in patients with lower extremity PAD was pooled using a random-effect model. Meta-regression, subgroup, and sensitivity analyses were conducted to explore the heterogeneity. Eighteen studies reported on 17 articles involving 1,726,343 patients with lower extremity PAD were identified. The pooled prevalence of frailty in patients with lower extremity PAD was 49% (95% confidence interval [CI] 37-61%), with significant heterogeneity between studies (I 2 =100%, p<0.001). Multivariable meta-regression showed that only the severity of PAD (coefficient 0.270; 95% CI 0.017-0.523, p=0.039) was significantly associated with the heterogeneity. In subgroup analysis, the pooled prevalence of frailty was higher in critical limb ischemia or chronic limb-threatening ischemia (54%) than all PAD (48%); the pooled prevalence of frailty was 64%, 51%, and 54% for Modified Frailty Index-5, Modified Frailty Index-11, and Clinical Frailty Scale, respectively. The pooled prevalence of frailty appeared to be lower in male (39%) than the female patients (47%). The prevalence of frailty was higher in patients with lower extremity PAD, suggesting frailty is a common condition. This finding highlights the significance of assessing frailty in patients with lower extremity PAD.

The Prevalence of Frailty in Patients on Peritoneal Dialysis

The Prevalence of Frailty in Patients on Peritoneal Dialysis

Frailty in the over 65’s undergoing elective surgery (FIT-65) – a three-day study examining the prevalence of frailty in patients presenting for elective surgery

BackgroundFrailty increases the risk of perioperative complications, length of stay, and the need for assisted-living after discharge. As the UK population ages the number of frail patients presenting for elective surgery in the UK is likely to grow. Despite the potential benefits of early diagnosis, frailty is not uniformly screened for in UK elective surgical patients and its prevalence remains unclear. The primary aim of this study was to assess the prevalence of frailty in patients aged over 65 years undergoing elective surgery.MethodsWe performed a prospective cross-sectional observational study in eight UK hospitals. Data were collected over three consecutive days with follow-up at 30 days. HRA approval was obtained (REC 20/SC/0121) and signed informed consent obtained. Participants were eligible for inclusion if they were 65 years or older and undergoing elective surgery. Pre-operative data were collected from hospital notes by anaesthetic trainees. A member of the research team blinded to the pre-operative dataset screened each participant for frailty pre-operatively using the Reported Edmonton Frail Scale (REFS). Post-operative data were collected from the notes on day of surgery and at 30 days. Participants were defined as “frail” if they scored 8 or more on the REFS.ResultsTwo hundred twenty eight participants were recruited during the study period of whom 218 proceeded to surgery. There were 103 females and 115 males. Median age was 75 years (interquartile range 70–80). Thirty-seven participants (17.0%) were identified as frail. Frail patients were older, had a higher ASA score, were more likely to have carers and were more likely to be anaemic or present with ECG abnormalities. There were no differences in gender, BMI, place of residence or smoking status for patients identified as frail versus non-frail. There was no difference in length-of-stay between frail and non-frail patients, although those identified as frail were less likely to be discharged to their own home.ConclusionWe found the prevalence of frailty in a mixed population of elective surgical patients aged 65 or over to be 17.0%. Furthermore, we found the REFS to be a practical tool for pre-operative frailty screening. Frail patients presented for elective surgery with modifiable co-morbidities which could have been optimised pre-operatively. Early screening could highlight frail patients, allowing time for pre-operative planning and evidence-based optimisations of comorbidities. We therefore encourage the adoption of frailty assessment as a routine part of pre-operative assessment.

Illuminating the need for a specific clinical care pathway for patients living with heart failure and identified as clinically frail.

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Against a background of increasing global population aging, frailty affects 8-10% of those over 65 years and 25-50% in those over 85 years. Frailty has a 4-6 times greater prevalence in heart failure patients and is increasingly recognised as a predictor of increasing hospitalisation and mortality in cardiovascular disease. The Rockwood Clinical Frailty Scale estimates an individual’s degree of frailty on a scale of 1(very fit) to 9 (terminally ill) with a score of 5 or greater indicating frailty. Purpose To estimate the 30-day prevalence of frailty in patients attending an ANP-led Heart Failure Clinic as a precursor to developing a clinical care pathway that systematically identifies frailty and triggers a comprehensive geriatric assessment. Methods A multi-centre audit was conducted in three hospitals in Ireland. We retrospectively audited consecutive patients attending three ANP-led HF clinics in November 2021 to assess the prevalence of frailty. Demographic data, NYHA classification, number of hospital admissions in the previous year, clinical Frailty Score (CFS) and the number of patients under the care of a geriatrician was obtained from the medical notes of 170 heart failure patients consecutively reviewed. CFS was calculated in those patients over 65 years. Results Of 376 HF reviews in November 2021, 170 individual patients were identified, 65% were male, 86% were aged 65ys or older of which 34% were over 80 years and a mean age of 73.4 years. 52% of the cohort were admitted at least once in the previous year of which 12% were admitted twice and 5% were admitted 3-4 times. 37% were classified as NYHA III and 0.6% were NYHA IV. The majority (68%) were newly diagnosed with HF within the previous year. 14% of patients were aged under 65yrs and did not have a CFS, 19% were deemed vulnerable (CFS 4), 41% were CFS 5 or greater and only 5% were under the care of a geriatrician. Conclusion(s) The prevalence of frailty (41%) was high in comparison with the national average of 24% and global average of 17%. Despite a strong association between age, frailty and heart failure, few patients were managed by a geriatrician. This audit emphasises the importance of developing a regional clinical care pathway that promptly recognises frailty in a high-risk population and triggers a comprehensive geriatric assessment. Furthermore, this audit highlights the limitations of the CFS in demonstrating cognitive and social vulnerability provoking further discourse in how patients are assessed and managed in the future.

Frailty in rheumatoid arthritis: A systematic review and meta-analysis.

Rheumatoid arthritis (RA) may cause damage to multiple organs and may further restrict the patient's physical, psychological and social functions. This meta-analysis aimed to explore the prevalence of frailty and prefrailty and the influential factors in RA patients. PubMed, Web of Science, Cochrane, Embase, and CNKI were searched to identify related articles. Articles published before July 23rd, 2021 that assessed frailty in patients with RA qualified for the systematic review and meta-analysis. A quality appraisal of the studies was performed using the Agency for Healthcare Research and Quality and Newcastle-Ottawa Scales. The pooled results were displayed as odds ratios or standardized mean differences (ORs/SMDs) and 95% confidence intervals (CIs). The article search generated 2273 articles, of which 16 satisfied the inclusion criteria and were merged in the final review. A total of 8556 RA patients were finally included. The pooled prevalence of frailty in the patients with RA was 33.5% (95% CI: 25.2-41.7%), and the pooled prevalence of prefrailty was 39.9% (95% CI: 29.4-50.3%). Subgroup analyses showed that frailty was more prevalent in females (24.7%) than in males (19.1%). The prevalence of prefrailty in females was similar to that in males among the RA patients. Frailty in RA was associated with the female sex (OR: 1.47, 95% CI: 1.04-2.07) and disease activity (OR: 1.47, 95% CI: 1.03-2.09). Frailty is prevalent in RA patients. Female gender and disease activity are associated with the prevalence of frailty in RA patients.

Frail patients having vascular surgery during the early COVID‐19 pandemic experienced high rates of adverse perioperative events and amputation

BackgroundFrailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision‐making about vascular surgery in the resource constrained COVID‐19 pandemic environment. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes.MethodsThe COVID‐19 Vascular Service in Australia (COVER‐AU) prospective cohort study evaluates 30‐day and six‐month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March–July 2020. The primary outcome was mortality, with secondary outcomes procedure‐related outcomes and hospital utilization. Frailty was assessed using the nine‐point visual Clinical Frailty Score, scores of 5 or more considered frail.ResultsOf the 917 patients enrolled, 203 were frail (22.1%). The 30 day and 6 month mortality was 2.0% (n = 20) and 5.9% (n = 35) respectively with no significant difference between frail and non‐frail patients (OR 1.68, 95%CI 0.79–3.54). However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non‐frail patients. At 6 months, frail patients had twice the odds of major amputation compared to non‐frail patients, after adjustment (OR 2.01; 95% CI 1.17–3.78), driven by a high rate of amputation during the period of reduced surgical activity.ConclusionOur findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress.

AB0626 Prevalence of Frailty in an Internet-Based Cohort with a Self-Reported Diagnosis of Vasculitis – The VascStrong Study

BackgroundFrailty is a syndrome characterized by an increased vulnerability to stressors and is associated with disability and early mortality. Frailty may be accelerated in patients with vasculitis. The prevalence of frailty in patients with vasculitis remains unexplored.ObjectivesTo describe the prevalence of self-reported frailty in patients with vasculitis.MethodsVascStrong is a longitudinal study utilizing the Vasculitis Patient-Powered Research Network (VPPRN), an internet-based prospective longitudinal cohort. Data elements collected included type of vasculitis, demographic, and use of medications. Frailty was measured by the FRAIL scale, a self-report measure which queries on 5 domains: 1. Fatigue, 2. Resistance (inability to climb 10 stairs), 3. Ambulation (inability to walk several blocks), 4. Illnesses (≥5/11 comorbidities), and 5. Loss of Weight (≥5% weight loss in the last year). Patients were classified as robust, pre-frail, and frail based on 0, 1-2, or ≥ 3 criteria, respectively.ResultsThe survey collected information from October 8, 2021-January 15, 2022. For this preliminary analysis, 228 responses were included. Clinical characteristics and study data are outlined in Table 1. Prevalence of robustness, pre-frailty, and frailty was 28.5%, 47.8%, and 23.7%, respectively. The majority of patients with each form of vasculitis were rated as frail or pre-frail. Among the individual FRAIL domains, fatigue and loss of weight were the most frequent (48.7% and 42.5%, respectively) while illnesses, was the least common (3.5%). When compared to robust patients, frail and pre-frail patients were younger, more frequently female, more likely to be obese and reported more frequent use of glucocorticoids. Patients with urticarial vasculitis and Takayasu’s arteritis were more commonly pre-frail or frail, compared to patients with other types of vasculitis.Table 1.Characteristics for overall cohort and by frailty classificationOverall N = 228Robust N = 65Pre-frail N = 109Frail N = 54Age, years, mean (SD)57.6 (15.3)62.4 (14.8)55.1 (15.6)57.1 (14.3)Sex, female163 (71.5%)40 (61.5%)84 (77.1%)39 (72.2%)Race, white204 (89.5%)60 (92.3%)98 (89.9%)46 (85.2%)Ethnicity, non-Hispanic195 (85.5%)57 (87.7%)97 (89.0%)41 (75.9%)Disease duration, years, mean (SD)8.5 (7.9)8.6 (6.8)8.4 (8.4)8.8 (8.0)Employment statusEmployed98 (43.0%)24 (36.9%)60 (55.0%)14 (26.0%)Retired66 (28.9%)29 (44.6%)24 (22.0%)13 (24.1%)Disabled (unable to work)34 (14.9%)4 (6.2%)12 (11.0%)18 (33.3%)Other/missing30 (13.2%)8 (12.3%)13 (12.0%)9 (16.7%)DiagnosisGranulomatosis with polyangiitis89 (100.0%)29 (32.6%)42 (47.2%)18 (20.2%)Eosinophilic granulomatosis with polyangiitis26 (100.0%)9 (34.6%)11 (42.3%)6 (23.1%)Microscopic polyangiitis23 (100.0%)7 (30.4%)12 (52.2%)4 (17.4%)Giant cell arteritis17 (100.0%)5 (29.4%)8 (47.1%)4 (23.5%)Urticarial vasculitis14 (100.0%)2 (14.3%)5 (35.7%)7 (50.0%)Takayasu's arteritis10 (100.0%)0 (0%)7 (70.0%)3 (30.0%)Other*49 (100.0%)8 (26.5%)16 (49.0%)8 (24.5%)Body Mass IndexaUnderweight6 (2.6%)2 (3.1%)4 (3.7%)0 (0%)Normal86 (37.7%)35 (53.8%)40 (36.7%)11 (20.4%)Overweight63 (27.6%)19 (29.2%)29 (26.6%)15 (27.8%)Obese73 (32.0%)9 (13.8%)36 (33.0%)28 (51.9%)Currently on glucocorticoids104 (45.6%)19 (29.2%)52 (47.7%)33 (61.1%)Current glucocorticoid dose, prednisone equivalent (mg/d), mean (SD)13.1 (18.0)12.6 (17.1)11.3 (18.6)16.4 (17.4)Data presented as n (%), unless specified otherwise*Other diagnosis: Behçet’s disease, primary angiitis central nervous system, cryoglobulinemic vasculitis, IgA vasculitis, polyarteritis nodosa, and other/suspected diagnosisaBased on World Health Organization Body Mass Index categoriesConclusionSelf-reported frailty or pre-frailty is prevalent in the majority of patients with multiple forms of vasculitis. Future analysis will focus on identifying factors associated with frailty in patients with vasculitis, to allow earlier identification and prevention in this population at high-risk for frailty.AcknowledgementsThe investigators want to thank all participants.Disclosure of InterestsSebastian E. Sattui Grant/research support from: receives research funding related to clinical trials by AstraZeneca (MANDARA), John Stadler: None declared, Cristina Burroughs: None declared, Kalen Larson: None declared, Peter A. Merkel Consultant of: CSL Behring, Dynacure, EMDSerono, Immagene, Jannsen, Kiniksa, Kyverna, Magenta, MiroBio, Mitsubishi, Novartis, Pfizer, Regeneron, Sparrow, Talaris, AbbVie, AstraZeneca, Boeringher-Ingelheim, Bristol-Myers Squibb, ChemoCentryx, Forbius, Genentech/Roche, Genzyme/Sanofi, GlaxoSmithKline, InflaRx, Neutrolis, Takeda., Grant/research support from: AbbVie, AstraZeneca, Boeringher-Ingelheim, Bristol-Myers Squibb, ChemoCentryx, Forbius, Genentech/Roche, Genzyme/Sanofi, GlaxoSmithKline, InflaRx, Neutrolis, Takeda., Robert Spiera Consultant of: Chemocentryx, Grant/research support from: Chemocentryx

Prevalence of frailty in patients with non-cirrhotic non-alcoholic fatty liver disease

ObjectiveEnd-stage chronic liver disease is associated with accelerated ageing and increased frailty. Frailty measures have provided clinical utility in identifying patients at increased risk of poor health outcomes, including those...

Frailty in Patients With Lung Cancer: A Systematic Review and Meta-Analysis

Previous studies regarding the prevalence of frailty in patients with lung cancer and mortality in frail patients with lung cancer are inconsistent and require clarification. What is the prevalence and impact of frailty in patients with lung cancer? This systematic review and meta-analysis used a combination of free-text terms and medical subject headings terms, according to the database requirements in MEDLINE/PubMed, Scopus, and Cochrane Library from inception until November 15,2020. A total of 2,571 articles were identified, and 16 articles involving 4,183 patients were included for study. The prevalence of frailty in lung cancer was 45%(95%CI, 28-61; I2= 99.5%; P< .0001). In patients with lung cancer, frailty was associated with an increased hazard ratio for mortality (hazard ratio, 3.01; 95%CI, 1.77-5.10; P< .001). The prevalence of frailty in lung cancer is 45%, which has a significant negative impact on survival of patients with lung cancer. These results highlight the importance of measuring frailty, which provides important prognostic information, and may provide opportunities for interventions to improve outcomes in patients with lung cancer.