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Published on: July 24, 2013
Association of Frailty With Transfusions, Hospitalizations, and Survival in Patients With Myelodysplastic Syndrome
Anahid Hamparsumian1, Jennifer La2,3, Mayuri Dharne3
1Duke University School of Medicine Durham North Carolina USA.
Introduction:
Prognostic scoring systems in MDS lack functional status measures. We sought to evaluate the influence of frailty on overall survival and care utilization in a national cohort. We conducted a retrospective study in the US Veterans Affairs Healthcare System of patients with MDS initiated on hypomethylating agents (HMAs) from 2004 to 2023. Frailty was measured using the Veterans Affairs-Frailty Index (VA-FI).
Methods:
For primary analyses, we evaluated the association between severity of frailty and overall survival via Kaplan-Meier analysis, followed by Cox proportional hazard regression models. Multivariable Poisson regression was used to evaluate transfusion incidence and unplanned hospitalizations. We identified 2285 veterans with MDS who initiated HMA treatment. The median age was 73.2 years. In addition, 34.0%, 30.6%, and 35.4% of veterans were classified as non-frail, mildly frail, and moderate-to-severely frail, respectively.
Results:
Moderate-to-severely frail veterans had a 49% higher hazard of death (aHR, 1.49; 95% CI, 1.34-1.67), as well as a higher incidence of transfusions (aIRR, 1.61; 95% CI, 1.45-1.80) and hospitalizations (aIRR, 1.58; 95% CI, 1.51-1.64).
Conclusion:
Increasing frailty was associated with higher rates of death, hospitalizations, and transfusions. Further research is needed to characterize how MDS-related contributors to frailty and non-oncologic aging-related factors mediate the increased risk of inferior outcomes in this population.
Trial Registration:
The authors have confirmed clinical trial registration is not needed for this submission.
Insights
Frailty significantly impacts myelodysplastic syndromes (MDS) patients treated with hypomethylating agents (HMAs). Moderate-to-severely frail individuals face higher mortality and increased healthcare utilization, including transfusions and hospitalizations.
Area of Science:
- Gerontology
- Hematology
- Clinical Epidemiology
Background:
- Prognostic scoring systems for myelodysplastic syndromes (MDS) often omit functional status measures.
- Frailty is a critical factor influencing health outcomes in elderly populations.
Purpose of the Study:
- To assess the impact of frailty on overall survival and healthcare utilization in a national cohort of MDS patients.
- To evaluate the Veterans Affairs-Frailty Index (VA-FI) as a measure of frailty in this population.
Main Methods:
- Retrospective study of 2285 US veterans with MDS initiating hypomethylating agent (HMA) treatment (2004-2023).
- Frailty assessed using the Veterans Affairs-Frailty Index (VA-FI).
- Kaplan-Meier and Cox regression for survival; Poisson regression for transfusion and hospitalization incidence.
Main Results:
- Moderate-to-severely frail veterans (35.4%) had a 49% higher hazard of death (aHR, 1.49).
- Higher incidence of transfusions (aIRR, 1.61) and hospitalizations (aIRR, 1.58) observed in frail individuals.
- Non-frail, mildly frail, and moderate-to-severely frail groups comprised 34.0%, 30.6%, and 35.4% of the cohort, respectively.
Conclusions:
- Increasing frailty is significantly associated with poorer outcomes in MDS patients, including higher mortality and increased healthcare resource utilization.
- Further research is warranted to understand the interplay of MDS-specific factors, aging, and frailty in predicting outcomes.
