scholarly journals A simplified frailty score predicts survival and can aid treatment intensity decisions in older DLBCL patients

2021 ◽  
Author(s):  
Kathrine T. Isaksen ◽  
Maria Adele Mastroianni ◽  
Marit Rinde ◽  
Leiv Sindre Rusten ◽  
Dlawer Abdulla Batzenje ◽  
...  
Keyword(s):  
Initial Dosage ◽  
B Cell Lymphoma ◽  
Treatment Intensity ◽  
Full Dose ◽  
Frailty Status ◽  
Risk Of Death ◽  
Frail Patients ◽  
Online Calculator ◽  
Frailty Score ◽  
Related Mortality

Diffuse large B-cell lymphoma (DLBCL) patients have a median age of 70 years. Yet, empirical knowledge on treatment for older patients is limited as they are frequently excluded from clinical trials. We aimed to construct a simplified frailty score and examine survival and treatment-related mortality (TRM) according to frailty status and treatment intensity in an older, real-world DLBCL population. All patients ≥70 years diagnosed with DLBCL 2006-2016 in south-eastern Norway (n=784) were included retrospectively, and divided into a training (n=522) and validation cohort (n=262). We constructed and validated a frailty score based on geriatric assessment variables, and examined survival and TRM according to frailty status and treatment. The frailty score identified three frailty groups with distinct survival and TRM, independent of established prognostic factors (2-year overall survival (OS) fit 82%, unfit 47%, frail 14%, P<0.001). For fit patients, full-dose R-CHOP (initial dosage>80%) was associated with better survival than attenuated R-CHOP (2-year OS 86% vs 70%, P=0.012), also in adjusted analysis. For unfit and frail patients, full-dose R-CHOP was not superior to attenuated R-CHOP, while an anthracycline-free regimen was associated with poorer survival in adjusted analyses. A simplified frailty score identified unfit and frail patients with higher risk of death and TRM, which can aid treatment intensity decisions in older DLBCL patients. In this study, fit patients benefit from full-dose R-CHOP, while unfit and frail patients have no benefit of full-dose R-CHOP over R-miniCHOP. An online calculator for assessment of the frailty score is available at https://wide.shinyapps.io/app-frailty/.

scholarly journals Use of the FRAIL Questionnaire in Patients With End-Stage Kidney Disease

2020 ◽  
Vol 7 ◽  
pp. 205435812095290
Author(s):  
Januvi Jegatheswaran ◽  
Ryan Chan ◽  
Swapnil Hiremath ◽  
Danielle Moorman ◽  
Rita S. Suri ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Medical Record ◽  
End Stage Kidney Disease ◽  
Ottawa Hospital ◽  
Frailty Status ◽  
Risk Of Death ◽  
Frail Patients ◽  
End Stage ◽  
To Receive

Background: Frailty is a clinical phenotype of decreased physiologic reserve that is associated with increased morbidity and mortality. The most meaningful way to assess frailty in patients with end-stage kidney disease (ESKD) is unknown. Objective: To assess the prevalence of frailty in ESKD patients using the easy-to-administer FRAIL scale and, to determine its association with mortality, transplantation, and hospitalization. Design: A cohort study was used. Setting: The Ottawa Hospital, Ottawa, Ontario, Canada, was the setting of this study. Patients: All eligible adult ESKD patients treated with dialysis from August to November 2017 at The Ottawa Hospital were invited to participate. Measurements: The FRAIL scale. Methods: Eligible patients completed an exercise survey with FRAIL questions embedded within the instrument. Number of comorbid illnesses was determined from the electronic medical record and weight loss was calculated from target weight in the patients’ dialysis prescription. Mortality, transplant status, and hospitalizations were ascertained from the electronic medical record 18 months later; differences by frailty status were evaluated using descriptive statistics. Kaplan-Meier and Cox regression models were used to examine the association between frailty and transplant. Results: Of 476 ESKD patients screened, 261 participated; 101 receiving peritoneal dialysis, 135 intermittent hemodialysis, and 25 home hemodialysis. Thirty-nine, 145, and 77 were frail, pre-frail, and not frail, respectively. Employment status, ethnicity, and comorbid illnesses differed significantly by frailty status, but mortality did not. In univariate analysis, frail patients were less likely to be listed for ( P = .05) and to receive a kidney transplant ( P = .02). However, after adjusting for age and modality, frailty was not statistically associated with a decreased likelihood of transplant (Hazard Ratio: 0.15; confidence interval [CI], 0.02-1.15; P = .068). The results were similar when accounting for the competing risk of death ( P = .060). Frail patients were more likely to be hospitalized ( P = .01) and spend more time in the hospital ( P = .04). Limitations: Single-center design with a relatively short follow-up and small sample size limiting the number of variables that could be assessed in analysis. We also excluded patients who were unable to communicate in English or French and those patients with physical limitations such as amputations, potentially affecting generalizability. Conclusions: Frail ESKD patients as identified by the FRAIL scale are less likely to receive a renal transplant; this association diminished statistically after adjusting for age and modality and when accounting for the competing risk of death. Frail patients were at increased risk of hospitalization. Further study with larger patient numbers and longer follow-up is needed to determine the usefulness of the FRAIL scale in predicting adverse outcomes. Trial registration: Not required as this was an observational study.

Evaluation of R-CHOP and R-CVP in the treatment of elderly patient with non-Hodgkin lymphoma

MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 1-6
Author(s):  
Truc Phan ◽  
Tram Huynh ◽  
Tuan Q. Tran ◽  
Dung Co ◽  
Khoi M. Tran
Keyword(s):  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
The Elderly ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Common Sign ◽  
Related Mortality

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam. Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed. Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens. Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.

An invasive strategy is associated with improved short- and long-term outcomes in acute myocardial infarction independently of frailty status and GRACE score: a nationwide analysis of 12144 episodes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Pessoa Amorim ◽  
D Santos-Ferreira ◽  
A Azul Freitas ◽  
H Santos ◽  
A Belo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Wald Test ◽  
Invasive Procedures ◽  
Frailty Status ◽  
Frail Patients ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
St Elevation ◽  
Grace Score

Abstract Introduction Frailty is common among patients presenting with acute myocardial infarction (MI), who have conflicting risks regarding benefits and harms of invasive procedures. Purpose To assess the clinical management and prognostic impact of invasive procedures in frail MI patients in a real-world scenario. Methods We analysed 5422 episodes of ST-elevation MI (STEMI) and 6692 of Non-ST-elevation MI (NSTEMI) recorded from 2010–2019 in a nationwide registry. A validated deficit-accumulation model was used to create a frailty index (FI), comprising 22 features [BMI >25kg/m2, myocardial infarction, angina, heart failure, percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), valvular disease, bleeding, pacemaker/implantable cardioverter defibrillator, chronic kidney disease (creatinine >2.0mg/dL), dialysis/renal transplant, stroke/transient ischaemic attack, diabetes, hypertension, dyslipidaemia, smoking, peripheral vascular disease, dementia, chronic lung disease, malignancy, polymedication (>3 cardiovascular drugs), admission haemoglobin <10g/dL; not including age]. Episodes with missing data on any FI parameter were not included. Frailty was initially defined as FI>0.25 (i.e. ≥6 features). Results Overall, 511 (9.4%) STEMI and 1763 (26.4%) NSTEMI patients were considered frail. Angiography, PCI and CABG were less frequently performed in frail patients (p<0.001). Delayed angiography (>72h) was more common among NSTEMI frail patients (p<0.001), and radial access was less commonly used overall (p<0.001). Guideline-recommended in-hospital medical therapy, including aspirin (NSTEMI), dual-antiplatelet therapy (STEMI/NSTEMI), heparin/heparin-related agents (NSTEMI), beta-blockers (STEMI) and ACEIs/ARBs (STEMI), was less commonly used in frail patients; discharge medical therapy exhibited similar patterns. Frail patients had longer hospital stay and increased in-hospital all-cause and cardiovascular (CV) mortality, as well as 1-year all-cause and CV hospitalization and all-cause mortality (p<0.001). Using receiver-operator-characteristics curve analysis, FI cutoffs of 0.11 (STEMI) and 0.20 (NSTEMI) yielded the best accuracy to predict 1-year all-cause mortality (area under the curve: 0.629 and 0.702 respectively, p<0.001) – these cutoffs were subsequently used to define frailty. Although frailty attenuated in-hospital risk reductions from angiography (STEMI/NSTEMI) and PCI (NSTEMI only) (Wald test p<0.05), their 1-year prognostic benefit remained unaffected (Wald test p>0.05). Angiography and PCI were associated with improved in-hospital and 1-year outcomes, independently of frailty status or GRACE score (p<0.001). Conclusion Frail MI patients are less commonly offered standard therapy; however, angiography and PCI were associated with short- and long-term prognostic benefits regardless of frailty status or GRACE score. Increased adherence to current recommendations might improve post-MI outcomes in frail patients. Invasive strategy and 1-year outcomes Funding Acknowledgement Type of funding source: Other. Main funding source(s): Portuguese Society of Cardiology

scholarly journals Catheter ablation can improve survival with the reduction of heart failure in frail patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Joung ◽  
P.S Yang ◽  
J.H Sung ◽  
E Jang ◽  
H.T Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Catheter Ablation ◽  
Real World ◽  
Background Characteristics ◽  
Risk Of Death ◽  
Frail Patients ◽  
Korean National Health Insurance

Abstract Background It is unclear whether catheter ablation is beneficial in frail patients with AF. Purpose This study aimed to evaluate whether catheter ablation reduces death and other outcomes in real-world frail patients with atrial fibrillation (AF). Methods Out of 801,710 patients with AF in the Korean National Health Insurance Service database from 2006 to 2015, 1,411 frail patients underwent AF ablations. The Hospital Frailty Risk Score were calculated retrospectively. Inverse probability of treatment weighting (IPTW) was used to categorize ablation and non-ablation frail groups. Results After IPTW, the two cohorts had similar background characteristics. During a median follow-up of 4.7 years (interquartile range: 2.2–7.8), the risk of death in frail patients with ablations was reduced by 65% compared to frail patients without ablations (2.0 and 6.4 per 100 person-years, respectively; hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.25–0.50; P<0.001). Ablations were related with a lower incidence and risk of heart failure admission (1.8 and 3.1 per 100 person-years, respectively; HR 0.66, 95% CI 0.44–0.98; P=0.042) and acute myocardial infarction (0.2 and 0.6 per 100 person-years, respectively; HR 0.30, 95% CI 0.15–0.62; P=0.001). However, the risk of stroke did not change after ablation. Conclussion Ablation may be associated with lower incidences of death, heart failure, and acute myocardial infarction in real-world frail patients with AF, supporting the role of AF ablation in these patients. The effect of frailty risk on the outcome of ablation should be evaluated in further studies. Funding Acknowledgement Type of funding source: None

scholarly journals Diabetes and Frail Older Patients: Glycemic Control and Prescription Profile in Real Life

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 115
Author(s):  
Anne-Sophie Mangé ◽  
Arnaud Pagès ◽  
Sandrine Sourdet ◽  
Philippe Cestac ◽  
Cécile McCambridge
Keyword(s):  
Glycemic Control ◽  
Older Patients ◽  
Diabetes Management ◽  
Real Life ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Frailty Status ◽  
Frail Patients ◽  
Patients With Diabetes ◽  
Hba1c Target

(1) Background: The latest recommendations for diabetes management adapt the objectives of glycemic control to the frailty profile in older patients. The purpose of this study was to evaluate the proportion of older patients with diabetes whose treatment deviates from the recommendations. (2) Methods: This cross-sectional observational study was conducted in older adults with known diabetes who underwent an outpatient frailty assessment in 2016. Glycated hemoglobin (HbA1c) target is between 6% and 7% for nonfrail patients and between 7% and 8% for frail patients. Frailty was evaluated using the Fried criteria. Prescriptions of glucose-lowering drugs were analyzed based on explicit and implicit criteria. (3) Results: Of 110 people with diabetes with an average age of 81.7 years, 67.3% were frail. They had a mean HbA1c of 7.11%. Of these patients, 60.9% had at least one drug therapy problem in their diabetes management and 40.9% were potentially overtreated. The HbA1c distribution in relation to the targets varied depending on frailty status (p < 0.002), with overly strict control in frail patients (p < 0.001). (4) Conclusions: Glycemic control does not seem to be routinely adjusted to the health of frail patients. Several factors can lead to overtreatment of these patients.

scholarly journals Hepatitis C virus infection and risk of liver-related and non-liver-related deaths: a population-based cohort study in Naples, southern Italy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pierluca Piselli ◽  
Diego Serraino ◽  
Mario Fusco ◽  
Enrico Girardi ◽  
Angelo Pirozzi ◽  
...  
Keyword(s):  
Southern Italy ◽  
Population Based ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Risk Of Death ◽  
High Prevalence ◽  
Specific Mortality ◽  
Chronic Hcv Infection ◽  
Chronic Hcv ◽  
Related Mortality

Abstract Background Hepatitis C virus (HCV) infection represents a global health issue with severe implications on morbidity and mortality. This study aimed to evaluate the impact of HCV infection on all-cause, liver-related, and non-liver-related mortality in a population living in an area with a high prevalence of HCV infection before the advent of Direct-Acting Antiviral (DAA) therapies, and to identify factors associated with cause-specific mortality among HCV-infected individuals. Methods We conducted a cohort study on 4492 individuals enrolled between 2003 and 2006 in a population-based seroprevalence survey on viral hepatitis infections in the province of Naples, southern Italy. Study participants provided serum for antibodies to HCV (anti-HCV) and HCV RNA testing. Information on vital status to December 2017 and cause of death were retrieved through record-linkage with the mortality database. Hazard ratios (HRs) for cause-specific mortality and 95% confidence intervals (CIs) were estimated using Fine-Grey regression models. Results Out of 626 deceased people, 20 (3.2%) died from non-natural causes, 56 (8.9%) from liver-related conditions, 550 (87.9%) from non-liver-related causes. Anti-HCV positive people were at higher risk of death from all causes (HR = 1.38, 95% CI: 1.12–1.70) and liver-related causes (HR = 5.90, 95% CI: 3.00–11.59) than anti-HCV negative ones. Individuals with chronic HCV infection reported an elevated risk of death due to liver-related conditions (HR = 6.61, 95% CI: 3.29–13.27) and to any cause (HR = 1.51, 95% CI: 1.18–1.94). The death risk of anti-HCV seropositive people with negative HCV RNA was similar to that of anti-HCV seronegative ones. Among anti-HCV positive people, liver-related mortality was associated with a high FIB-4 index score (HR = 39.96, 95% CI: 4.73–337.54). Conclusions These findings show the detrimental impact of HCV infection on all-cause mortality and, particularly, liver-related mortality. This effect emerged among individuals with chronic infection while those with cleared infection had the same risk of uninfected ones. These results underline the need to identify through screening all people with chronic HCV infection notably in areas with a high prevalence of HCV infection, and promptly provide them with DAAs treatment to achieve progressive HCV elimination and reduce HCV-related mortality.

503 Clinical Frailty Score (CFS) Vs Antibiotics, Time to Surgery and Time to Computerised Tomography (CT) Scan in An Emergency Surgical Population

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Palaniappan ◽  
R Soiza ◽  
S Moug ◽  
P Myint
Keyword(s):  
Ct Scan ◽  
Emergency Laparotomy ◽  
Antibiotic Administration ◽  
Process Measures ◽  
Time To Surgery ◽  
Performance Time ◽  
Frail Patients ◽  
Management Plans ◽  
Administration Time ◽  
Frailty Score

Abstract Introduction Frail patients have increased mortality after surgery. However, it is not known if pre-operative process measures such as antibiotic administration, time to CT and time to surgery are influenced by patient frailty. Method The Emergency Laparotomy and Laparoscopy Scottish Audit (ELLSA) assessed outcome after emergency surgery across Scottish hospitals (November 2017 – October 2018). Frailty was measured using the 7-point Clinical Frailty Score (CFS). Outcome measures were antibiotic provision for sepsis, admission to CT time, admission to surgery time, CT request to performance time and CT request to surgery time. Results 1302 patients (median age 63 years [IQR 49-74]; 49% male) with complete data were included. Median time from admission to CT and surgery increased between those with CFS 1 to 6/7 from 597 to 1724 minutes (p &lt; 0.0001) and 1556 to 4120 minutes (p &lt; 0.0001) respectively. Time from CT request to surgery also significantly increased with CFS (p &lt; 0.042). There was no significant association between CFS and antibiotic administration or CT request to performance. Conclusions Frail patients have to wait longer for CT scan requests and surgery, but frailty was not associated with antibiotic administration or delays in CT request to performance time. Possible explanations include frailty-related challenges making correct diagnoses and optimal management plans.

scholarly journals 160 The Effect of Frailty and COVID-19 Infection on Clinical Outcomes in Older Adults—A Single Centre Retrospective Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
O Okuwoga ◽  
S Mufti
Keyword(s):  
Older Patients ◽  
Single Centre ◽  
Clinical Frailty Scale ◽  
Health Records ◽  
Frail Patients ◽  
Nice Guidance ◽  
Data Points ◽  
Continued Use ◽  
Support Decision Making ◽  
Frailty Score

Abstract Introduction It was anticipated that the COVID-19 pandemic would put a strain on our healthcare system, disproportionately affecting older people. NICE guidance recommended using frailty scoring to support decision making around escalation of care. This study aimed to assess frailty, demographics and COVID-19 infection and to investigate how these related to outcomes of patients aged over 65 years admitted to hospital. Methods A single centre retrospective cohort study was carried out by reviewing the electronic health records of all admissions over 65 years. Data points collected included length of stay (LOS), frailty score using the Rockwood Clinical Frailty Scale (CFS) and mortality. Patients were stratified into COVID and non-COVID based on health records and into non-frail (CFS 1–4) and frail (CFS 5–9). Results A total of 257 patients admitted between 30th March and 30th April 2020 were included in the study (mean age 79 years, 43% female). 141 (54.9%) of patients were diagnosed with COVID-19 infection. 120 patients had CFS 1–4 and 136 has CFS 5–9. 1 patient did not have a frailty score due to insufficient information. 68 (26.8%) of all patients died during the admission. The relative risk (RR) of mortality of patients with coronavirus was 6.3 (95% CI 3.1–12.6, p &lt; 0.0001). The RR of mortality for frail patients compared to the non-frail was 2.1 (95% CI 1.3–3.2, p = 0.002). The median LOS for patients with COVID-19 was 5 days, compared to 4 days for patients who did not have coronavirus. Frailty did not predict longer admission, with median LOS of 5 days for both non-frail and frail patients. Conclusion The results demonstrated in this study show that COVID-19 infection and frailty were significantly associated with increased mortality in older patients. This validates the continued use of frailty scoring of older patients on admission to support care planning.

Higher sRAGE Levels Predict Mortality in Frail Older Adults with Cardiovascular Disease

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Lee Butcher ◽  
Jose Antonio Carnicero ◽  
Karine Pérès ◽  
Marco Colpo ◽  
David Gomez Cabrero ◽  
...  
Keyword(s):  
Older Adults ◽  
Cox Regression ◽  
Population Based ◽  
Blood Levels ◽  
Roc Curve Analysis ◽  
Baseline Serum ◽  
Frailty Status ◽  
Risk Of Death ◽  
Survival Difference ◽  
Increased Risk

<b><i>Introduction:</i></b> The evidence that blood levels of the soluble receptor for advanced glycation end products (sRAGE) predict mortality in people with cardiovascular diseases (CVD) is inconsistent. To clarify this matter, we investigated if frailty status influences this association. <b><i>Methods:</i></b> We analysed data of 1,016 individuals (median age, 75 years) from 3 population-based European cohorts, enrolled in the FRAILOMIC project. Participants were stratified by history of CVD and frailty status. Mortality was recorded during 8 years of follow-up. <b><i>Results:</i></b> In adjusted Cox regression models, baseline serum sRAGE was positively associated with an increased risk of mortality in participants with CVD (HR 1.64, 95% CI 1.09–2.49, <i>p</i> = 0.019) but not in non-CVD. Within the CVD group, the risk of death was markedly enhanced in the frail subgroup (CVD-F, HR 1.97, 95% CI 1.18–3.29, <i>p</i> = 0.009), compared to the non-frail subgroup (CVD-NF, HR 1.50, 95% CI 0.71–3.15, <i>p</i> = 0.287). Kaplan-Meier analysis showed that the median survival time of CVD-F with high sRAGE (&#x3e;1,554 pg/mL) was 2.9 years shorter than that of CVD-F with low sRAGE, whereas no survival difference was seen for CVD-NF. Area under the ROC curve analysis demonstrated that for CVD-F, addition of sRAGE to the prediction model increased its prognostic value. <b><i>Conclusions:</i></b> Frailty status influences the relationship between sRAGE and mortality in older adults with CVD. sRAGE could be used as a prognostic marker of mortality for these individuals, particularly if they are also frail.

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