Frailty and clinical outcomes in chronic obstructive pulmonary disease

NETT Research Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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 26.8; 95% CI, 210.0 to 23.6; P, 0.001), and physical composite scores on Medical Outcomes Survey Short Form-36 (mean difference 216.7; 95% CI, 221.3 to 212.1; 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.

Original languageEnglish (US)
Pages (from-to)217-224
Number of pages8
JournalAnnals of the American Thoracic Society
Volume16
Issue number2
DOIs
StatePublished - Feb 1 2019

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Chronic Obstructive Pulmonary Disease
Confidence Intervals
Emphysema
Forced Expiratory Volume
Phenotype
Hospitalization
Quality of Life
Respiratory Muscles
Mortality
Muscle Strength
Random Allocation
Geriatrics
Dyspnea
Biomedical Research
Body Mass Index
Therapeutics
Exercise
Morbidity
Incidence
Health

Keywords

  • COPD
  • Frailty
  • Hospitalizations
  • Quality of life
  • Survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Frailty and clinical outcomes in chronic obstructive pulmonary disease. / NETT Research Group.

In: Annals of the American Thoracic Society, Vol. 16, No. 2, 01.02.2019, p. 217-224.

Research output: Contribution to journalArticle

@article{995898c861614c14a808da6984dbc5db,
title = "Frailty and clinical outcomes in chronic obstructive pulmonary disease",
abstract = "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 26.8; 95{\%} CI, 210.0 to 23.6; P, 0.001), and physical composite scores on Medical Outcomes Survey Short Form-36 (mean difference 216.7; 95{\%} CI, 221.3 to 212.1; 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.",
keywords = "COPD, Frailty, Hospitalizations, Quality of life, Survival",
author = "{NETT Research Group} and Cassie Kennedy and Novotny, {Paul J.} and LeBrasseur, {Nathan K} and Wise, {Robert A.} and Sciurba, {Frank C.} and Benzo, {Roberto P} and Fishman, {A. P.} and Bozzarello, {B. A.} and A. Al-Amin and M. Katz and C. Wheeler and E. Baker and P. Barnard and J. Carter and S. Chatziioannou and K. Conejo-Gonzales and J. Haddad and D. Hicks and N. Kleiman and M. Milburn-Barnes and C. Nguyen and M. Reardon and J. Reeves-Viets and S. Sax and A. Sharafkhaneh and C. Young and R. Espada and R. Butanda and K. Dubose and M. Ellisor and P. Fox and K. Hale and E. Hood and A. Jahn and S. Jhingran and K. King and C. Miller and I. Nizami and T. Officer and J. Ricketts and J. Rodarte and R. Teague and K. Williams and J. Reilly and D. Sugarbaker and C. Fanning and S. Body and Utz, {James P} and Sanjay Kalra and Midthun, {David Eric}",
year = "2019",
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day = "1",
doi = "10.1513/AnnalsATS.201803-175OC",
language = "English (US)",
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TY - JOUR

T1 - Frailty and clinical outcomes in chronic obstructive pulmonary disease

AU - NETT Research Group

AU - Kennedy, Cassie

AU - Novotny, Paul J.

AU - LeBrasseur, Nathan K

AU - Wise, Robert A.

AU - Sciurba, Frank C.

AU - Benzo, Roberto P

AU - Fishman, A. P.

AU - Bozzarello, B. A.

AU - Al-Amin, A.

AU - Katz, M.

AU - Wheeler, C.

AU - Baker, E.

AU - Barnard, P.

AU - Carter, J.

AU - Chatziioannou, S.

AU - Conejo-Gonzales, K.

AU - Haddad, J.

AU - Hicks, D.

AU - Kleiman, N.

AU - Milburn-Barnes, M.

AU - Nguyen, C.

AU - Reardon, M.

AU - Reeves-Viets, J.

AU - Sax, S.

AU - Sharafkhaneh, A.

AU - Young, C.

AU - Espada, R.

AU - Butanda, R.

AU - Dubose, K.

AU - Ellisor, M.

AU - Fox, P.

AU - Hale, K.

AU - Hood, E.

AU - Jahn, A.

AU - Jhingran, S.

AU - King, K.

AU - Miller, C.

AU - Nizami, I.

AU - Officer, T.

AU - Ricketts, J.

AU - Rodarte, J.

AU - Teague, R.

AU - Williams, K.

AU - Reilly, J.

AU - Sugarbaker, D.

AU - Fanning, C.

AU - Body, S.

AU - Utz, James P

AU - Kalra, Sanjay

AU - Midthun, David Eric

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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 26.8; 95% CI, 210.0 to 23.6; P, 0.001), and physical composite scores on Medical Outcomes Survey Short Form-36 (mean difference 216.7; 95% CI, 221.3 to 212.1; 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.

AB - 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 26.8; 95% CI, 210.0 to 23.6; P, 0.001), and physical composite scores on Medical Outcomes Survey Short Form-36 (mean difference 216.7; 95% CI, 221.3 to 212.1; 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.

KW - COPD

KW - Frailty

KW - Hospitalizations

KW - Quality of life

KW - Survival

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JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

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