Frailty and Associated Outcomes in Patients With Vasculitis

Abstract

Objective: To describe the frequency and outcomes associated with self-reported frailty in patients with vasculitis.

Methods: VascStrong is a longitudinal study using the Vasculitis Patient-Powered Research Network, an internet-based cohort of patients with vasculitis. Data collected included patient global assessment (PtGA) and several domains of the Patient-Reported Outcomes Measurement Information System (PROMIS). Frailty was measured at baseline and 1-year follow-up using the FRAIL scale, a 5-domain self-reported measure. Patients were classified as nonfrail, prefrail, and frail based on 0, 1-2, or ≥ 3 criteria, respectively. At follow-up, patients reported the occurrence over the prior year of hospitalizations, infections, fractures, and disease flares. A multivariable logistic regression was performed to identify factors associated with frailty.

Results: The baseline survey included 328 patients. Patients had a mean age of 59.5 years, were predominantly female (71.6%) and non-Hispanic White. Prevalence of prefrailty and frailty was 42.1% and 21.6%, respectively. The majority of patients with each form of vasculitis were classified as frail or prefrail. Prefrail and frail patients reported worse PROMIS scores at baseline and follow-up. Frailty was independently associated with female sex, higher PtGA scores, being overweight, and obesity, but not with age. At 1 year, 272 of 328 (82.9%) patients answered the follow-up survey. Transitions in frailty status were observed in 99 (36.4%) patients. Hospitalizations and flares were more frequent in frail patients.

Conclusion: Self-reported frailty or prefrailty is common in the majority of patients with multiple forms of vasculitis, indicating there is a substantial subset of patients at risk for worse outcomes.

Keywords: ANCA vasculitis; frailty; quality of life; vasculitis.