SAT0650-HPR WHAT CAN WE LEARN FROM A ROUTINE FRAILTY ASSESSMENT IN RHEUMATOLOGY? A SERVICE EVALUATION OF 170 NEW PATIENT REFERRALS TO A SINGLE RHEUMATOLOGY CENTRE.
Authors: N. Cleaton, J. Bateman
Journal: Annals of the Rheumatic Diseases (2020)

Background: Frailty is common among patients with rheumatological diseases, and there is increasing evidence that it is associated with poorer outcomes. Frailty scores worsen during the course of chronic inflammatory arthritis (IA) and connective tissue disease (CTD). Existing tools such as the Rockwood Clinical Frailty Scale (a nine-point scale from 1 very fit- 9 severely frail) allow for rapid frailty assessment by doctors and nurses. Frailty assessment is recommended by NHS England as an important public health opportunity for targeted interventions for both primary and secondary care. We have limited understanding of frailty in rheumatology new patient cohorts, and it is not routinely assessed in most centres. We report the feasibility and utility of frailty scores in patients referred to rheumatology, and association with final diagnosis. Objectives: This service evaluation assesses the utility and feasibility of implementing the Rockwood Clinical Frailty Score for new patient referrals at a single UK centre. Methods: New patient assessments at a rheumatology consultant general new patient clinic were prospectively coded over 9-months (March- December 2019). Anonymised coded demographic data included: age, gender, referral source, history of depression, RFCS and clinical diagnosis (coded against established categories, those requiring further tests coded ‘awaiting investigations’). RCFS coding was assisted by an online validated pictorial aide memoir for coding. Results: Of the 181 referrals, 11 (6%) were excluded for incomplete data. The mean age of the remaining 170 patients was 53 years (SD 16.8; range 17-87), predominantly female (123/170; 72%). Most referrals, 57% (97/170) were from primary care, 23% (39/170) from musculoskeletal integrated triage services, 5% (9/170) from orthopaedics, 4% (7/170) from gastroenterology; 18 were from 12 secondary-care specialties. The RCFS was: mean 2.6 (median 2, range 1-7) with depression in 61/170 (36%), but no effect of this on mean RCFS (2.6 in both). RCFS increased with age (70-79, n=21, mean 2.9; &gt;80, N=12, 4.3). The majority of patients had non-inflammatory (NI) diagnoses (119/170, 70%) e.g. osteoarthritis, fibromyalgia. Overall 19% (32) ‘inflammatory arthritis’ (IA; rheumatoid arthritis, psoriatic, undifferentiated inflammatory arthritis, gout); 4% (6) were diagnosed with a form of connective tissue disease (undifferentiated CTD; SLE; Sjogren’s syndrome); 8% (13) were awaiting further investigations. Patients in both the NI and IA category were found to have an average RCFS of 2.6 (SD, NI 1.1; IA 0.9). Patients who received a diagnosis of CTD had an average RCFS of 3.5 (SD 1.8). We identified 30 patients who scored four or more (vulnerable/ at risk) for targeted intervention by therapy and allied health professionals. The RCFS was positively evaluated by clinicians. Conclusion: RFCS was simple to introduce to our centre and has provided us with additional data to plan our service provision for primary and secondary care support for our cohort. Our new patients with CTD, and who were elderly had higher frailty scores, we found no association between frailty and depression or presence of IA or NI. The RCFS was easy to use and can be integrated into routine clinical practice for new and follow up patients. Further studies are required to support these findings. References: [1]Haider, S., Grabovac, I., Berner, C., et al. Frailty in seropositive rheumatoid arthritis patients of working age: a cross-sectional study. Clinical and experimental rheumatology. 2018. [2]Katz PP, Andrews J, Yazdany J, et al. Is frailty a relevant concept in SLE? Lupus Science &amp; Medicine 2017;4:e000186. [3]ALPAY M, CASSEM EH. Diagnosis and treatment of mood disorders in patients with rheumatic disease. Annals of the Rheumatic Diseases 2000;59:2-4. Disclosure of Interests: None declared