Abstract
Background
Pleural disease (PD) is common, representing 5% of the acute medical workload and its incidence is rising, partly due to the ageing population. Frailty is an important feature and little is known about disease progression in patients with frailty and PD. We aimed to examine the effect of frailty on mortality and other relevant outcomes in patients diagnosed with PD.
Methods
The national secure anonymised information linkage databank was used to identify a cohort of individuals diagnosed with PD. Frailty was assessed at diagnosis of PD using an electronic frailty index. The primary outcome was time from diagnosis to all-cause mortality. Data were analysed using multilevel mixed-effects cox proportional hazards regression adjusting for pre-specified covariates age, deprivation, smoking status, comorbidity, and subtype of PD.
Findings
In Wales 54,566 individuals were diagnosed with PD between 1st January 2005 and 1st March 2023 (median age 66 years; 49% female). By the end of the study, 25,698 (47.1%) had died, with a median follow-up time of 1.0 years (IQR 0.2-3.6). There was an increasing association between worsening frailty and all-cause mortality, as well as hospitalisation, and 90-day hospital readmission. Compared to fit individuals, there was increasing mortality for those with mild (aHR=1.11, 95%CI 1.08-1.15), moderate (aHR=1.25, 95%CI 1.20-1.31), and severe frailty (aHR=1.36, 95%CI 1.28-1.44).
Interpretation
Independent of age and comorbidities, frailty status at diagnosis of PD exhibited utility as a prognostic indicator. Patients that were moderately (or severely frail) experienced a rapid decline in health. Future patients should be assessed for frailty at the time of diagnosis of PD and may benefit from optimised care and advance care planning.
Pleural disease (PD) is common, representing 5% of the acute medical workload and its incidence is rising, partly due to the ageing population. Frailty is an important feature and little is known about disease progression in patients with frailty and PD. We aimed to examine the effect of frailty on mortality and other relevant outcomes in patients diagnosed with PD.
Methods
The national secure anonymised information linkage databank was used to identify a cohort of individuals diagnosed with PD. Frailty was assessed at diagnosis of PD using an electronic frailty index. The primary outcome was time from diagnosis to all-cause mortality. Data were analysed using multilevel mixed-effects cox proportional hazards regression adjusting for pre-specified covariates age, deprivation, smoking status, comorbidity, and subtype of PD.
Findings
In Wales 54,566 individuals were diagnosed with PD between 1st January 2005 and 1st March 2023 (median age 66 years; 49% female). By the end of the study, 25,698 (47.1%) had died, with a median follow-up time of 1.0 years (IQR 0.2-3.6). There was an increasing association between worsening frailty and all-cause mortality, as well as hospitalisation, and 90-day hospital readmission. Compared to fit individuals, there was increasing mortality for those with mild (aHR=1.11, 95%CI 1.08-1.15), moderate (aHR=1.25, 95%CI 1.20-1.31), and severe frailty (aHR=1.36, 95%CI 1.28-1.44).
Interpretation
Independent of age and comorbidities, frailty status at diagnosis of PD exhibited utility as a prognostic indicator. Patients that were moderately (or severely frail) experienced a rapid decline in health. Future patients should be assessed for frailty at the time of diagnosis of PD and may benefit from optimised care and advance care planning.
| Original language | English |
|---|---|
| Journal | The Lancet Healthy Longevity |
| Publication status | Accepted/In press - 10 Jun 2024 |