DuMontier Clark, Fillmore Nathanael R, Yildirim Cenk, Cheng David, La Jennifer, Orkaby Ariela R, Charest Brian, Cirstea Diana, Yellapragada Sarvari, Gaziano John Michael, Do Nhan, Brophy Mary T, Kim Dae H, Munshi Nikhil C, Driver Jane A
New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA 02130, USA.
Division of Aging, Brigham and Women's Hospital, Boston, MA 02115, USA.
Cancers (Basel). 2021 Jun 18;13(12):3053. doi: 10.3390/cancers13123053.
Electronic frailty indices based on data from administrative claims and electronic health records can be used to estimate frailty in large populations of older adults with cancer where direct frailty measures are lacking. The objective of this study was to use the electronic Veterans Affairs Frailty Index (VA-FI-10)-developed and validated to measure frailty in the national United States (US) VA Healthcare System-to estimate the prevalence and impact of frailty in older US veterans newly treated for multiple myeloma (MM) with contemporary therapies. We designed a retrospective cohort study of 4924 transplant-ineligible veterans aged ≥ 65 years initiating MM therapy within VA from 2004 to 2017. Initial MM therapy was measured using inpatient and outpatient treatment codes from pharmacy data in the VA Corporate Data Warehouse. In total, 3477 veterans (70.6%) were classified as frail (VA-FI-10 > 0.2), with 1510 (30.7%) mildly frail (VA-FI-10 > 0.2-0.3), 1105 (22.4%) moderately frail (VA-FI-10 > 0.3-0.4), and 862 (17.5%) severely frail (VA-FI-10 > 0.4). Survival and time to hospitalization decreased with increasing VA-FI-10 severity (log-rank -value < 0.001); the VA-FI-10 predicted mortality and hospitalizations independently of age, sociodemographic variables, and measures of disease risk. Varying data sources and assessment periods reclassified frailty severity for a substantial portion of veterans but did not substantially affect VA-FI-10's association with mortality. Our study supports use of the VA-FI-10 in future research involving older veterans with MM and provides insights into its potential use in identifying frailty in clinical practice.
基于行政索赔数据和电子健康记录的电子衰弱指数，可用于在缺乏直接衰弱测量方法的情况下，估算大量老年癌症患者的衰弱情况。本研究的目的是使用电子退伍军人事务部衰弱指数（VA-FI-10）——该指数已在美国全国退伍军人事务部医疗保健系统中开发并验证用于测量衰弱情况——来估算采用当代疗法新治疗的美国老年多发性骨髓瘤（MM）退伍军人中衰弱的患病率及其影响。我们设计了一项回顾性队列研究，研究对象为2004年至2017年在退伍军人事务部开始接受MM治疗的4924名年龄≥65岁且不符合移植条件的退伍军人。初始MM治疗通过退伍军人事务部企业数据仓库中药房数据的住院和门诊治疗代码来衡量。总共有3477名退伍军人（70.6%）被归类为衰弱（VA-FI-10>0.2），其中1510名（30.7%）为轻度衰弱（VA-FI-10>0.2至0.3），1105名（22.4%）为中度衰弱（VA-FI-10>0.3至0.4），862名（17.5%）为重度衰弱（VA-FI-10>0.4）。随着VA-FI-10严重程度的增加，生存率和住院时间缩短（对数秩检验P值<0.001）；VA-FI-10独立于年龄、社会人口统计学变量和疾病风险指标预测死亡率和住院情况。不同的数据源和评估期对相当一部分退伍军人的衰弱严重程度进行了重新分类，但并未实质性影响VA-FI-10与死亡率的关联。我们的研究支持在未来涉及老年MM退伍军人的研究中使用VA-FI-10，并为其在临床实践中识别衰弱的潜在用途提供了见解。
