Contemporary Analysis of Electronic Frailty Measurement in Older Adults with Multiple Myeloma Treated in the National US Veterans Affairs Healthcare System

SIMPLE SUMMARY: Geriatric and frailty assessment are recommended for all older adults with cancer undergoing systemic therapy, but assessments remain difficult to scale. The aim of this study was to use an electronic frailty index based on data from administrative claims and electronic health records—the Veterans Affairs Frailty Index (VA-FI-10)—to estimate frailty and its impact on older United States (US) military veterans treated for multiple myeloma (MM) throughout the national VA Healthcare System. We found frailty to be prevalent and strongly associated with mortality and hospitalizations—independently of age, race, and MM stage. We also showed that changing the way in which the VA-FI-10 is measured affects its classification of frailty for individual veterans but not its association with mortality. These findings support the VA-FI-10’s use in research investigating outcomes in frail veterans treated with contemporary MM therapies. We provide further insights into the VA-FI-10’s potential use in clinical practice. ABSTRACT: Electronic frailty indices based on data from administrative claims and electronic health records can be used to estimate frailty in large populations of older adults with cancer where direct frailty measures are lacking. The objective of this study was to use the electronic Veterans Affairs Frailty Index (VA-FI-10)—developed and validated to measure frailty in the national United States (US) VA Healthcare System—to estimate the prevalence and impact of frailty in older US veterans newly treated for multiple myeloma (MM) with contemporary therapies. We designed a retrospective cohort study of 4924 transplant-ineligible veterans aged ≥ 65 years initiating MM therapy within VA from 2004 to 2017. Initial MM therapy was measured using inpatient and outpatient treatment codes from pharmacy data in the VA Corporate Data Warehouse. In total, 3477 veterans (70.6%) were classified as frail (VA-FI-10 > 0.2), with 1510 (30.7%) mildly frail (VA-FI-10 > 0.2–0.3), 1105 (22.4%) moderately frail (VA-FI-10 > 0.3–0.4), and 862 (17.5%) severely frail (VA-FI-10 > 0.4). Survival and time to hospitalization decreased with increasing VA-FI-10 severity (log-rank p-value < 0.001); the VA-FI-10 predicted mortality and hospitalizations independently of age, sociodemographic variables, and measures of disease risk. Varying data sources and assessment periods reclassified frailty severity for a substantial portion of veterans but did not substantially affect VA-FI-10’s association with mortality. Our study supports use of the VA-FI-10 in future research involving older veterans with MM and provides insights into its potential use in identifying frailty in clinical practice.