Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

Abstract

Background Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Objectives We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. Methods A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants

“…We found that apixaban was associated with not only a reduction in clinical events but also a smaller risk of home time lost greater than 14 days during 365 days, a threshold that correlated with worsening mobility impairment, depression, and difficulty in self-care . The association favoring apixaban was stronger among beneficiaries with frailty, reflecting the higher background risks and disease burden in patients with frailty …”

Family Physician Prescribing Practices and Perspectives on Shared Decision-Making Regarding the Use of Oral Anticoagulants for Stroke Prevention in Patients 75 Years or Older With Atrial Fibrillation

“… 26 Frail older patients are less likely to receive anticoagulation with warfarin in both inpatient and outpatient settings, are significantly more likely to experience embolic stroke and have higher mortality rates; but do not have a significantly increased risk of major hemorrhage. 27 In a recent large cohort study of AF patients, the clinical benefit of OAC was maintained in AF patients with varying levels of frailty, including those with moderate to high levels of frailty but not in end-stage frailty. 28 It is therefore important to recognize that frailty alone should not preclude the use of OACs in elderly patients with AF.…”

DIGItal Health Literacy after COVID-19 Outbreak among Frail and Non-Frail Cardiology Patients: The DIGI-COVID Study

“…Frailty is a clinical syndrome that is frequently found in cardiology patients, characterized by reduced physiological reserve and increased vulnerability to stressors [ 38 , 39 ]. Several studies reported that frail patients are associated with an increased risk of adverse outcomes, thus requiring structured and holistic clinical management [ 38 , 40 ].…”