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Frailty and Clinical Outcomes in Chronic Obstructive Pulmonary Disease.

Publication ,  Journal Article
Kennedy, CC; Novotny, PJ; LeBrasseur, NK; Wise, RA; Sciurba, FC; Benzo, RP
Published in: Ann Am Thorac Soc
February 2019

RATIONALE: Frailty represents an increased vulnerability to adverse health outcomes. The frailty phenotype conceptual model (three or more patient attributes of wasting, exhaustion, low activity, slowness, and weakness) is associated with increased morbidity and mortality in geriatric populations. OBJECTIVES: Our objective was to describe the risks associated with frailty in patients with chronic obstructive pulmonary disease. METHODS: Data from the National Emphysema Treatment Trial (NETT) were retrospectively analyzed. The frailty phenotype conceptual model was operationalized as three or more frailty parameters (a body mass index decrease of ≥5% over 12 months, self-reported exhaustion, low 6-minute walk distance, or physical activity or respiratory muscle strength in the lowest quartile). Frail participants were compared with participants with two or fewer frailty parameters. Participants were followed starting 12 months after NETT randomization (to minimize surgical effect) for 24 months. Univariate, multivariate, Kaplan-Meier, and Cox proportional hazard analyses were performed, adjusting for treatment arm, age, modified Medical Research Council dyspnea scale, sex, and baseline forced expiratory volume in 1 second (FEV1). Multiple imputation was used for missing values. RESULTS: The participants (N = 902) were predominantly white (94.5%) males (59.5%), with a median age of 67 years (interquartile range, 63-70 yr) and a median FEV1% predicted of 26 (interquartile range, 20-33). Six percent of the participants (95% confidence interval [CI], 4.5 to 7.6) were frail. The incidence rate of frailty was 6.4 per 100 person-years. Frail participants reported significantly worse disease-specific and overall quality of life by St. George's Respiratory Questionnaire total score (mean difference of 11.6; 95% CI, 7.6 to 15.6; P < 0.001), mental composite on Medical Outcomes Survey Short Form-36 (mean difference -6.8; 95% CI, -10.0 to -3.6; P < 0.001), and physical composite scores on Medical Outcomes Survey Short Form-36 (mean difference -16.7; 95% CI, -21.3 to -12.1; P = 0.001). Frail participants had an increased rate of hospitalization (adjusted hazard ratio, 1.6; 95% CI, 1.1 to 2.5; P = 0.02) and an adjusted increase in hospital use of 8.0 days (95% CI, 4.4 to 11.6; P < 0.001) compared with nonfrail participants. Frail participants had a higher mortality rate (adjusted hazard ratio, 1.4; 95% CI, 0.97 to 2.0; P = 0.07). CONCLUSIONS: Among adults with chronic obstructive pulmonary disease, our measure of frailty (modified from the Fried frailty phenotype) was associated with incident and longer-duration hospitalization, and with poor quality of life.

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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

February 2019

Volume

16

Issue

2

Start / End Page

217 / 224

Location

United States

Related Subject Headings

  • Walk Test
  • United States
  • Survival Analysis
  • Surveys and Questionnaires
  • Retrospective Studies
  • Quality of Life
  • Pulmonary Disease, Chronic Obstructive
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Kennedy, C. C., Novotny, P. J., LeBrasseur, N. K., Wise, R. A., Sciurba, F. C., & Benzo, R. P. (2019). Frailty and Clinical Outcomes in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc, 16(2), 217–224. https://doi.org/10.1513/AnnalsATS.201803-175OC
Kennedy, Cassie C., Paul J. Novotny, Nathan K. LeBrasseur, Robert A. Wise, Frank C. Sciurba, and Roberto P. Benzo. “Frailty and Clinical Outcomes in Chronic Obstructive Pulmonary Disease.Ann Am Thorac Soc 16, no. 2 (February 2019): 217–24. https://doi.org/10.1513/AnnalsATS.201803-175OC.
Kennedy CC, Novotny PJ, LeBrasseur NK, Wise RA, Sciurba FC, Benzo RP. Frailty and Clinical Outcomes in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2019 Feb;16(2):217–24.
Kennedy, Cassie C., et al. “Frailty and Clinical Outcomes in Chronic Obstructive Pulmonary Disease.Ann Am Thorac Soc, vol. 16, no. 2, Feb. 2019, pp. 217–24. Pubmed, doi:10.1513/AnnalsATS.201803-175OC.
Kennedy CC, Novotny PJ, LeBrasseur NK, Wise RA, Sciurba FC, Benzo RP. Frailty and Clinical Outcomes in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2019 Feb;16(2):217–224.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

February 2019

Volume

16

Issue

2

Start / End Page

217 / 224

Location

United States

Related Subject Headings

  • Walk Test
  • United States
  • Survival Analysis
  • Surveys and Questionnaires
  • Retrospective Studies
  • Quality of Life
  • Pulmonary Disease, Chronic Obstructive
  • Middle Aged
  • Male
  • Humans