Abstract Rationale Frailty is increasingly recognized as a determinant of poor outcomes in chronic obstructive pulmonary disease (COPD), yet how comorbidities interact with frailty to influence risk remains unclear. The Electronic Frailty Index (eFI) offers an EHR-based measure of cumulative health deficits, including 34 comorbidities, that enables automated risk stratification. Patients are assigned an eFI score categorized as fit (0.10), pre-frail (0.10-0.21), or frail (≥0.21). Our previous research showed that pre-frail and frail patients with COPD experience worse outcomes compared to fit. This study expands on that work by examining the comorbidities that compose the eFI to better characterize multimorbidity burden in COPD. Methods We conducted a retrospective cohort study of 24,929 adults with COPD within our health system (2021-2024). Patients were identified if they had ≥2 ICD billing codes (J41-J44) during a two-year lookback period (2021-2023). Each was assigned an eFI score and classified as fit, pre-frail, or frail. Outcomes were analyzed over one year (2023-2024). We evaluated prevalence of the 34 eFI comorbidities across frailty groups and their association with hospitalization using logistic regression, overall and stratified by frailty category. Results Comorbidity prevalence increased across frailty categories. Cardiovascular disorders—heart failure (OR 2.20, 95% CI 2.01-2.44), atrial fibrillation (OR 1.37, 95% CI 1.23-1.53), and myocardial infarction (OR 1.37, 95% CI 1.19-1.58)—along with diabetes (OR 1.54, 95% CI 1.41-1.69) and dyspnea (OR 1.41, 95% CI 1.30-1.54) were the strongest overall predictors of hospitalization. When stratified by frailty group, heart failure consistently predicted hospitalization among fit (OR 2.09, 95% CI 1.45-2.92), pre-frail (OR 2.24, 95% CI 1.90-2.64), and frail (OR 1.96, 95% CI 1.63-2.36) groups. Dyspnea showed similar patterns (fit OR 1.72, 95% CI 1.29-2.28; pre-frail OR 1.54, 95% CI 1.33-1.80; frail OR 1.43, 95% CI 1.21-1.70). Atrial fibrillation was a top predictor in pre-frail (OR 1.53, 95% CI 1.25-1.85) and frail (OR 1.35, 95% CI 1.13-1.60) groups but was not significant among fit. In contrast, myocardial infarction was the strongest predictor among fit (OR 2.28, 95% CI 1.29-3.90) but not significant in pre-frail or frail groups. Skin ulcers increased risk in fit (OR 1.73, 95% CI 0.91-3.09) and pre-frail (OR 1.62, 95% CI 1.23-2.10) groups but not in frail. Conclusion The eFI identifies distinct comorbidity patterns that increase hospitalization risk in COPD. By examining the 34 comorbidities composing the eFI, we can better understand multimorbidity in COPD and use eFI-based profiles to target patients for early intervention and resource optimization This abstract is funded by: None
Ivey et al. (Fri,) studied this question.