Abstract
Purpose :
Frailty describes the loss of biological reserves across multiple organ systems. An electronic frailty index (eFI) quantifying 54 total deficits and integrated within the Electronic Health Record was previously developed by Callahan et al. at Wake Forest University and has been associated with adverse postsurgical outcomes, Emergency Department visits and hospitalizations. We hypothesize that the eFI is associated with decreased rates of follow up in patients with diabetic retinopathy.
Methods :
We performed a retrospective chart review of all patients with diabetic retinopathy that had undergone an initial eye examination by a retina specialist at Wake Forest Baptist Health from January 1, 2017 to December 31, 2019. Data was collected for up to 2 years from the first visit with the retina specialist. Outcomes including loss to follow-up (LTFU) status (defined as a failure to return to the clinic for 20 days or more past the recommended follow up time) were compared against the available eFI.
Results :
Of the total 249 patients included, 203 (81.5%) were lost to follow up at some point during the study period. There is a statistically significant relationship between LTFU and patients considered to be Pre-fail (eFI 0.1-0.21) or Frail (eFI >0.21) than compared to Fit patients (eFI <0.1) (p=0.007). The level of eFI does not have a significant impact on visual acuity outcomes (p=0.9494) or duration of follow up (p=0.6). Patients in the pre-frail group had a higher rate of intravitreal bevacizumab injections (p=0.02).
Conclusions :
Patients with higher eFI have higher rates of loss to follow up in the retina clinic. Frailty index can be a powerful tool in predicting loss to follow up and choosing treatments in patients with diabetic retinopathy, especially when considering anti-vascular endothelial growth factor injections for patients with proliferative diabetic retinopathy. To our knowledge, no prior studies have researched the association of eFI and loss to follow up in patients with diabetic retinopathy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.